Re: Shoulder dystocia/legal impact
From: art fougner, md (evsono@pipeline.com)
Mon Aug 14 18:19:11 2000
amen, Dr. Meenan - but i get the sense that this woman wants both
tastes great and less filling. i have to blieve Betsy explained the
vagaries of efw by ultrasound, and when she informed this woman that
shoulder dystocia is by and large unpredictable, the lady's reply was
disbelief, followed by the implied threat of litigation. there is
literature to suggest that one instance of shoulder dystocia conveys a
higher risk of same in subsequent pregnancies although admittedly hard
to quantitate.
mine is simply a "gut feeling" and nothing more. Betsy, Good Luck and
pls let us know how her delivery works out.
art
At Mon, 14 Aug 2000, Anna Meenan, MD wrote:
>
>At Sun, 13 Aug 2000, art fougner, md wrote:
>>
>>and i suppose she's not going to allow epis as well? this woman is a
>>manipulator.
>>
>>art
>>
>>--
>>art fougner, md
>>
>>A series of 1000 cases begins with but a single anecdote.
>>
>So, art, a patient who prefers not to have a largely unnecessary
>surgical procedure is manipulative? And yes, I know the question of
>whether an episiotomy is necessary in managing a shoulder dystocia is
>still being debated (we debated it in this forum several months back),
>but I have never found it to be a particularly useful maneuver and I
>believe we came to the conclusion that those who were doing them were
>mainly doing them for the benefit of the lawyers.
>
>I am unable to get a sense of whether this patient is being
>confrontative and demanding or whether she is just trying to educate
>herself. If she was my patient, I would explain to her that it is
>virtually impossible to get a good estimate of fetal size prenatally,
>that shoulder dystocia can occur at almost any term fetal size, give her
>the statistics on recurrent shoulder dystocia, and document the hell out
>of the whole conversation. If the baby APPEARED to be smaller than the
>previous one at term and the lady wanted a vaginal delivery, I would
>allow a trial of labor with the caveat that a deviation from normal
>progress with good contractions would generate a strong recommendation
>for a c-section, and if this occurred, I would again document the hell
>out of that conversation. If the patient refused c-section during an
>abnormal or protracted labor, I would document that also, and if a
>shoulder dystocia occurred, I would carefully follow the ALSO protocol,
>documenting times and maneuvers every step of the way, being careful to
>document that any traction used was gentle traction. From my experience
>as an expert witness in two shoulder dystocia cases, that would pretty
>well cover all the bases to make the lawyers happy, but I suppose that
>wouldn't stop her from at least attempting to sue anyway.
>
>Well, that's my 2 cents worth, anyway.
>
>--
> Anna Meenan, MD, FAAFP
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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