Re: Another Interesting VBAC
From: art fougner, md (evsono@pipeline.com)
Sat Jul 8 14:38:57 2000
perhaps the problem with the section rate is not that it's too high?
perhaps the section rate is too low?
art
At Sat, 8 Jul 2000, Geffrey Klein, MD wrote:
>
>At 1:31 AM -0500 on 7/8/00, 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 .
>
>agree that it is reasonable not to do ECV with prior CS.
>
>> No further
>>Uss done . Physician felt baby vtx . Pt . told him she did not feel baby move
>>and kicking was in the same places. .
>
>sloppy. I suspect this means that the cervix was not even dilated
>enough to feel the presenting part.
>
>>Induced labor at 40 weeks and 4 days .- Started cervidil am - day one .
>
>Induction of prior cs with cervidil in direct violation of package insert.
>
>>( 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 .
>
>still not enough data.. cervical exam, progress, and tracing the
>most important details here...
>
>--
>_______________________
>Geffrey H. Klein, MD
>_______________________
>geffrey.klein@obgyn.net
>200 Medical Center Blvd Suite 103
>Webster, TX 77598
>(281) 332 6723
>
>http://www.geffreyklein.com
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
