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Re: VBAC of >1 previous C/S- Malcolm's response From: dahmd@gate.net Tue Jul 15 12:35:43 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Bernard Cristalli: "Re: Peritoneal Closure" Previous message: Dr. Amarnath Bhide/Rajendra Deshpande: "Re: Peritoneal Closure" Laurie Lovely wrote: At my residency, which was > military (with lots of transfers of care, lack of records, etc.) we used > to let patients with prior C-section and undocumented scars labor "under > close observation" as long as the story of the C-section wasn't too > scary ("I just didn't dilate"). Laurie- These patients caused fainting spells in residents during my training. The attending during the day, for example, would be "pro VBAC" and would allow labor under "close observation" and continuous monitoring even if the patient presented with an undocumented scar. Of course, the attending coming on at 5pm would say something like "WHAT! Get that lady in the OR now!" when he or she found out about the undocumented scar. The poor residents ended up getting reamed either way. I remember one case where a lady with an undocumented scar (turns out it was low-transverse) actually got a c/section at complete/complete/0 station with a reassuring tracing! I can still hear people yelling "don't push....don't push...!" Now that *I'm* the attending I take great care to present both sides of the story to the patient who presents with an undocumented scar. In almost all cases she will decide without hesitation which way she wants to go. If she gives a good "story" suggestive of a low-transverse incision, and strongly desires a VBAC, then I will usually consent, with the understanding that disaster may strike. If she is too worried or her history is more suggestive of a classical (or vertical) c/section, then I'll readily do a repeat c/section. Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL Next message: Bernard Cristalli: "Re: Peritoneal Closure" Previous message: Dr. Amarnath Bhide/Rajendra Deshpande: "Re: Peritoneal Closure"

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