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Re: Sometimes breeches are just meant to be born vaginally.From: Dr. Bülent Potur (bpotur@yahoo.com)Fri May 30 03:57:56 2008
Two experiences reminding Murphy: 1) Complete effacement and dilatation. Frank breech. Primiparous (second delivery) patient. Encouragement of the patient to bear down. Occasional fhr deceleration. And then an abrupt terminal fetal bradicardia. Vaginal extraction and delivery. Cord wrapped four times around the neck. So this caused a very short cord. 2) a 69 twin 9 coming first.Then locked twins. Me and my peers had some older brother (assistant professor) when we were being trained in the teaching hospital who would ask "Haven't you ever delivered primigravida breeches?" when we were trying to section. So we had in deed delivered some primigravida breeches during residency with no adverse outcomes. So when a specialist I would section primigravida breeches and allow the midwives to perform delivery of multipara breeches. Above, The first example was my personal experience more than a decade ago. In the second I was the Obgyn on call, the experience was of a midwife. Nowadays if not imminently delivering I tend to section all breeches. Greetings from Türkiye. Bülent Potur --- 30/05/08 Cum tarihinde Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. <johnprov@sympatico.ca> ºöyle yaz¹yor: Kimden: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. <johnprov@sympatico.ca> Konu: Re: Sometimes breeches are just meant to be born vaginally. Kime: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net> Tarihi: 30 May¹s 2008 Cuma, 10:31 At Fri, 30 May 2008, Dr Eberhard W Lisse wrote: > >If we could only know in advance... > >If the core had been compromised we would not be so sure any more >whether the C/S had been necessary... > >el > And if Mom died from an aspiration,spesis,pulmonary embolus,bleedind... we would not be sure whether we did a section for an easy Vag breach delievery. I.E. try and remove as much risk to the baby as possible and in the process lose Mom. The Golden rule is and always will be Mom comes first. Moreover you can make a strong arguement that for a 34 wk frank breach this late in the second stage a c-section may be just as traumatic to baby if not more so than a vaginal delievery.
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Take care, John
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