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CS response timeFrom: Joe Cutchin (forcep@shore.intercom.net)Mon Jul 17 19:06:02 2000
Sometime last fall I had written to ACOG and complained about the word"immediate" in terms of MD availability.I found Dr Zoinberg's response and am posting for your interest. Dear Dr Cutchin. Your recent e-mail regarding the Practice Bulletin "Vaginal Birth after Previous Cesarean Delivery"has been forwarded to me as Vice President of Practice Activities.Unfortunately,Ken Heland is no longer with the College and I have been asked to respond. As indicated in the enclosed editorial in our newsletter ACOG Today,the term "immediate" was used in this document to highlight the urgent need for intervention in the event of uterine rupture.In contrast to other obstetric emergencies such as placenta accreta,VBAC is a purely procedure that allows for reasonable precautions in assuming this small but significant risk.In addition,recognition that certain situations require less than a 30 minute reponse time does not represent new College policy.As explained in "Guidelines for Prenatal Care 4th Ed" examples of situations mandating expeditious delivery include "hemmorrhage from placenta accreta,prolapse of the umbilical cord,and uterine rupture".Therefore the Practice Bullitin merely emphasizes this point. The definition of "immediate available" remains a local decision,based on each institution's available resources and geographic location. I hope this information is helpful to you. Sincerely, Stanley Zinbery,MD,MS,FACOG Vice President,Practice Activities
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Joseph H. Cutchin MD FACOG 4105463125
314 West Carroll Street 4105463128 Fax
Salisbury,Maryland 21801
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