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Re: Another Interesting VBAC From: Tonya Von Brooks, CPM (nbwc@ix.netcom.com) Sat Jul 8 01:30:52 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey Klein, MD: "Re: Another Interesting VBAC" Previous message: Steve & Eryl Raymond: "Re: Rectal Misoprostol for Postpartal hemorrhage" Next in thread: Geffrey Klein, MD: "Re: Another Interesting VBAC" Reply: Geffrey Klein, MD: "Re: Another Interesting VBAC" Geff , I was able to obtain a little more data on the vbac case I posted .Here it is although far from complete Three weeks before labor the baby was dx'd as breech . The physician decline a request for a version on a scarred uterus . No further Uss done . Physician felt baby vtx . Pt . told him she did not feel baby move and kicking was in the same places. . Induced labor at 40 weeks and 4 days .- Started cervidil am - day one . Pt desired vbac and natural childbirth .Cervidil for 12 hours produced Uc's 30 seconds long and 2 minutes apart .Pt reports Uc's seemed painful . erratic tracing by external monitor . It was difficult to keep monitor on fetal heart . Fhr was found to be high on abdomen but it was difficult to get a good tracing . ( I don't know why they didn't use an internal monitor - this Pt. might have refused it .) HR baselines were between 125 and 115 . Pt reported very painful uc's although monitor did not show strong uc's . 8 pm one dose Stadol . 9 pm physician came in and started iv pit . Pt given 2 or 3 more doses of Stadol between 9 pm and 3 am . Given epidural anesthesia around 3 am . Fell asleep for one hour woke up to enormous pain around pubic bone . Pt was catheterized and checked by nurse who " couldn't find the cervix " . No fetal heart tones. C/S at around 4:25am. Baby was breech . Feet delivered first . I do not know any other details of position . Pt was given 2 units of blood ,baby to nicu and expired a few days later . I don't know what to make of this case .I think we have to vbac those candidates who do not require much intervention yet it's a choice I want women to have . Tonya "Geffrey Klein, MD" wrote: > At 3:24 PM -0500 on 7/2/00, RModugno@aol.com wrote: > > >In a message dated 7/2/00 2:35:20 PM Eastern Daylight Time, gklein@icsi.net > >writes: > > > ><< Back to Tonya's case... > > > > The doc did not know the baby was breech. > > Had the doc known the baby was breech, (s)he might have done a cesarean. > > Had the doc done a cesarean, there would have been no uterine rupture. > > However, the doc's failure to know the presentation was not the > > proximate cause of the uterine rupture. (S)he may have very well > > allowed a trial of labor. > > > > If, you were to tell me that the labor was not progressing > > adequately, that signs of fetal distress were ignored, or that the > > patient was complaining of characteristic abdominal pain between > > contractions yet no action was taken, well then, I would agree with > > you.. >> > > > >Then, without all the facts, one cannot make an intelligent comment on the > >case. > > Not true.. I believe Tonya's intent was to present a case that was > equally as mismanaged as the case I presented. Based on the facts > that she presented, I have yet to conclude that the doctor committed > malpractice. My default is not to assume malpractice until given > the data which leads me to conclude it.. What is your default? > > -- > _______________________ > Geffrey H. Klein, MD > _______________________ > geffrey.klein@obgyn.net > 200 Medical Center Blvd Suite 103 > Webster, TX 77598 > (281) 332 6723 > > http://www.geffreyklein.com Next message: Geffrey Klein, MD: "Re: Another Interesting VBAC" Previous message: Steve & Eryl Raymond: "Re: Rectal Misoprostol for Postpartal hemorrhage" Next in thread: Geffrey Klein, MD: "Re: Another Interesting VBAC" Reply: Geffrey Klein, MD: "Re: Another Interesting VBAC"

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