Re: Another Interesting VBAC
From: Tonya Von Brooks, CPM (nbwc@ix.netcom.com)
Sat Jul 8 10:47:19 2000
James ,
One couldn't dx strength of ucs and the tracing wasn't very good either . I suspect
the cervix was not very dilated for internal monitoring . But I don't have records
other than my report from Pt. I don't know the protocol used for the pit either . The
only reason I made that comment is the Pt reported to the nurses pain above pubis even
though her ucs didn't appear strong . She was coached by her Mom , a nurse who is
trained to read a strip .
Tonya
james connerth wrote:
> "monitor did not show strong uc's--" Internal??? How does one dx strength from
> toco??
>
> "Tonya Von Brooks, CPM" wrote:
>
> > 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
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