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Re: Prior cesarean, SGA, need your help.... (off the subject..)From: Geffrey H. Klein, MD (gklein@bcm.tmc.edu)Wed Jul 30 22:42:11 1997
>I know this isn't the point of your post but I'd like to ask the >following: What is your approach to the patient that refuses TOL? How >aggressive are you when you know she could, even should go with a TOL >but just refuses? I've got a patient right now, G2P1 with a prior >section, no contraindications for VBAC with this pregnancy. Just won't >hear of it. Sort of acts a little militant about the whole thing. I counsel with risks and benefits as follows: 1) Better to deliver vaginally. 2) Risk of uterine rupture up to 1% (if known LUT) 3) consequences of uterine rupture potentially but not always devastating (fetal harm/death, maternal hemorrhage, hysterectomy, blood transfusion, etc) 4) elective cesarean less morbid than repeat cesarean after failed TOL 5) chance of successful VBAC 60-80% 6) morbidity from elective cesarean greater than that of vaginal delivery. 7) encourage trial of labor However, if patient says repeat cesarean, that is the END OF DISCUSSION. Bottom line, it is her body. She has thought it through and it is a reasonable request. She gets what she wants. If she elects for TOL and then in labor requests cesarean, I do it. BTW, Dr. Flamm has a great editorial piece in this months Green about VBAC and TOL.. A must read.. ---------------------------------- Geffrey H. Klein, MD ---------------------------------- gklein@bcm.tmc.edu -- ---------------------------------- http://members.aol.com/gklein01/geff.html List-owner OB-GYN-L co-moderator sci.med.obgyn Advisory Board Chairman OBGYN.net http://www.obgyn.net/medical.htm Office: 2200 Nasa Rd #1 Houston, Texas 77058 Tel 713 741 2273 x2628 page 713 415 4395
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