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Re: 17 Minute Rule From: ainsron@msn.com Wed Feb 14 16:08:01 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Paul Prior MD: "Re: VBAC, immediate availability" Previous message: Braun, R. Daniel: "Re: 17 Minute Rule" In reply to: Dean Huffman: "17 Minute Rule" The "rule" is in an editorial in the October 1997 Green Journal by Flamm, and his reference for this "rule" is a 1994 article in the Gray Journal by Leung. Here's the direct quote from the editorial: If a return to the days of "once a cesarean, always a cesarean" is not the answer, what is? I believe it is a more cautious approach to VBAC. In 99% of cases, labor after previous cesarean is much like any other labor. But we must never forget that in approximately 1% of cases the uterus will rupture. To avoid catastrophes, we must always be ready to move quickly. A prolonged deceleration of the FHR is often the first warning sign of uterine rupture. If this occurs, every second counts. A large study on uterine rupture found that no infants had significant perinatal morbidity when delivered within 17 minutes of the onset of a prolonged deceleration. The conclusion seems to be that if a prolonged deceleration to 90 beats per minute or less lasting more than 1 minute occurs during a trial of labor, you should perform an immediate cesarean operation. Do not waste time performing an ultrasound examination or counting instruments. In many such cases you will find no uterine rupture, but in other cases you will have saved a baby's life. >Regarding the "17 minute rule", I have searched the entire federal and >state legal database in WestLaw and I can find no mention of the "17 minute >rule" in any appellate cases. The search was done about two months ago. If >anybody has a more recent search and has found an appellate reference to >the 17 minute rule, please let me know. > >-- >Dean Huffman, M.D. >Perinatl@bigfoot.com > >- - - - > >Re: VBAC, immediate availabilty and change in hospital policy >From: ainsron@msn.com >Sun, 11 Feb 2001 19:23:51 -0600 (CST) > >Several posts dating back to 1997 regarding this topic, here is the most >concise one: The "17 minute rule" is mentioned in Bruce Flamm's excellent >editorial "Once a Cesarean, Always a Controversy" in Aug 97 Green Journal >(Obstet Gynecol 1997;90:312-5). He states, "A large study (19) on uterine >rupture found that no infants had significant perinatal morbidity when >delivered within 17 minutes of the onset of a prolonged deceleration." The >reference on this large study is Leung et al, Am J Obstet Gynecol >1993;169:945-50. >One further note is needed, apparently this study only had seven patients >and the only one that had problems was outside of the 17 minute cut-off, >ergo what some have called the 17 minute rule. I doubt you are truly brain >dead, but if we aren't careful and speedy, apparently our patients might be. > >>Must have been brain dead at the time - but what is the 17 minutes about? >> >>Robert Modugno MD MBA FACOG >>Marietta, GA > >-- >Ronald E. Ainsworth, MD > >---------------------------------------------------------------------------- >---- >---------------------------------------------------------------------------- >---------------------------------------------------------------------------- >---------------------------------------------------------------------------- > >---------------------------------------------------------------------------- > >---------------------------------------------------------------------------- >---------------------------------------------------------------------------- -- Ronald E. Ainsworth, MD Next message: Paul Prior MD: "Re: VBAC, immediate availability" Previous message: Braun, R. Daniel: "Re: 17 Minute Rule" In reply to: Dean Huffman: "17 Minute Rule"

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