Re: What's next
From: Joe (forcep@intercom.net)
Fri Apr 25 06:45:26 2008
This is why our CS rate will approach 50% shortly and in 10-20 years
ACOG will not exist. Joe C
Efrain Ramirez wrote:
> One of the reasons I presented this case was ACOGs' comments regarding
> this issue .. IMHO -- ACOG's wording has been awful...
> as you said – it’s a no win situation.. where EBM, experience and gut
> feeling can’t get together and reach an intelligent course of action as
> before.. nowadays you have to think from the outcome backwards- put
> your 20/20 eyeglasses and draw the course.. it’s madness..
> Thanks for you thoughtful comments
> Ef
> At Thu, 24 Apr 2008, Charles Bloom wrote:
>
>>This case is a perfect example of one of the many frequent and challenging
>>conundrums we face in medicine.
>>
>>To answer your question, there is no way to prevent litigation in the US,
>>only to increase your chances of prevailing. ACOG’s statement I believe was
>>to address the very issue presented by this case. Prior to that, it was very
>>unlikely for you to be sued for premature delivery if there was any
>>intrauterine fetal compromise. You mostly got sued for damaged or dead
>>babies. The problem is that now we are stuck walking a tightrope and
>>frequently there is no possible good outcome. As an example, if we somehow
>>knew that an IUGR fetus was going to suffer hypoxic brain injury at 32 weeks
>>(of course there is no way we could know this precisely in advance), we
>>would have been forced to deliver before that and the fetus would be in the
>>NICU for a long time and possibly have residual long term effects. If we
>>deliver too late, it’s an easy malpractice suit. Now, if we could even
>>miraculously manage to deliver the day before the fetus suffered permanent
>>neurological damage, there would be no way to prove that it was at the last
>>possible moment and we run the risk of being accused of delivering too
>>early. A no win situation. And as you said, informed consent is very helpful
>>here, if for no other reason than to involve the family in the medical plan.
>>
>>I think the best we can do is frequent testing and deliver at the first sign
>>of demonstrable fetal compromise by any of the testing parameters we’re
>>using or at the EGA we feel will not pose a prematurity risk if the testing
>>remains perfect.
>>
>>--
>>Charles Bloom, MD
>>http://www.smartob.com
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Laureano
>>Folgar
>>Sent: Thursday, April 24, 2008 7:09 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: What's next
>>
>>As Dan said, that is the late preterms we are talking about. The "state
>>or art" is an hemodynamic strictly follow up till term or suspected
>>foetal compromised. The "litigation fear recommendation" is cs now.
>>So, is "litigation fear recommendation" a good reason as ACOG recommended?.
>>I´m not familiarized with US laws, but a well informed consent clearly
>>reported in the clinical history, does not avoid a litigation?.
>>
>>L. Folgar.
>>
>>Efrain Ramirez escribió:
>>
>>>No fetal weight gain at all in the last 2 weeks.. umbilical artery
>>>doppler normal.. MCA not done.. mother perceives fewer FM's.. just
>>>like the other pregnancy.
>>>Definitive asymmetric IUGR.
>>>Level III NICU .. I had to deliver in the last year to babies at 26
>>>weeks .. doing well..
>>>Steroids? – it’s a Democratic Primary..
>>>Legally speaking an unexpected IUFD would be hard to defend... NICU
>>>complications, IMHO, easier.
>>>Thanks to all.. recommendations well taken…
>>>
>>>Ef
>>
>
> --
> "I can accept failure, but I can't accept not trying." - Michael Jordan
>
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