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Re: Within or outside the standard of careFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed May 30 16:28:34 2001
Witness the problem of getting older. I "LEARNED" it from a former technical bulletin and then didn't "UNLEARN" it when it wasn't even mentioned on the newer one. How about that? They went from absolutely condemn9ing it to completely ignoring it. I personally would not include the physician going out of town as a psychosocial reason. I would consider it to be more of an ego thing or perhaps financial if she/he had to pay someone else to cover. When I was at Scott and White, we did a survey of our patients on the issue of how important it was for their Doc to be present for the delivery. When it was given during the prenatal course, Itt was close to mandatory for 100%. When we had them do the survey at their postpartal visit, only 25% thought that it mattered at all. When a large percentage of your "NEW" OB patients come in at 28 to 30 weeks with 4 months of prenatal care with another Doc and the reason is that their husband's insurance changed and their other Doc is no longer on the list. (That is how important it is to them to have "THEIR" Doc present. Dan PS sorry about the ranting. -----Original Message----- From: Larry Glazerman [mailto:l.glazerman@rcn.com] Sent: Wednesday, May 30, 2001 4:02 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Within or outside the standard of care Dan: Where do they say this?????? Here is a quote from the 1999 Technical Bulletin including their statement on "logistic reasons", which include psychosocial indications. · What are the indications and contraindications to induction of labor? Indications for induction of labor are not absolute but should take into account maternal and fetal conditions, gestational age, cervical status, and other factors. Following are examples of maternal or fetal conditions that may be indications for induction of labor: · Abruptio placentae · Chorioamnionitis · Fetal demise · Pregnancy-induced hypertension · Premature rupture of membranes · Postterm pregnancy · Maternal medical conditions (eg, diabetes mellitus, renal disease, chronic pulmonary disease, chronic hypertension) · Fetal compromise (eg, severe fetal growth restriction, isoimmunization) · Preeclampsia, eclampsia Labor also may be induced for logistic reasons, for example, risk of rapid labor, distance from hospital, or psychosocial indications. In such circumstances, at least one of the criteria in the box should be met or fetal lung maturity should be established (28). Generally, the contraindications to labor induction are the same as those for spontaneous labor and vaginal delivery. They include, but are not limited to, the following situations: · Vasa previa or complete placenta previa · Transverse fetal lie · Umbilical cord prolapse · Previous transfundal uterine surgery However, the individual patient and clinical situation should be considered in determining when induction of labor is contraindicated. Several obstetric situations are not contraindications to the induction of labor but do necessitate special attention. These include, but are not limited to, the following: At 09:49 AM 5/30/01 -0500, you wrote:
>ACOG defines elective induction of labor as "An induction done only for the
-- Larry R. Glazerman, MD Ob-Gyn at Trexlertown 610-402-0161 l.glazerman@rcn.com
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