Re: OB: How to deliver
From: gklein@icsi.net
Tue Jan 29 19:40:38 2002
Section
Geffrey Klein,MD
----Original Message-----
>From: garrys@mindspring.com (Garry Siegel)
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.medispecialty.com>
>Subj: OB: How to deliver
>Reply To: ob-gyn-l@obgyn.net
>Sent: Tuesday, January 29, 2002 8:08 PM
>
>OK, here's one to kick around a bit.
>
>25 YO P1001 at 16 weeks, good dates, in for a routine visit. At her
>first visit, with our CNM (who does office only), she described a
>difficult vaginal delivery with a shoulder dystocia, of a 9 pound, 2
>ounce baby, who went home with her 3 days later, with no sequelae, birth
>trauma, etc. The patient used the word, "Vaginal C/Section," duly
>written onto our prenatal by our office RN. The patient was not
>diabetic in that pregnancy.
>
>At the visit, the patient told the CNM that she was told that she should
>have C/Sections in future pregnancies, and that apparently is how the
>issue was left. 1 hour glucose screening was done, and was 111 mg/dl (I
>think that those are the right units).
>
>Well, I just saw her and went over the above, and requested records (but
>likely the progress notes/written delivery note will not have the detail
>needed). I told her that I would like to review things, once available,
>and then discuss options.
>
>Would you:
>
>1. Say "screw it" and just plan a section at term without labor.
>2. Try to press her into a vaginal attempt, carefully conducted, or
>course.
>3. Hope the records come, review them, and then deal with it. That
>said, the basic choices will still be "1" or "2".
>4. Make a tentative plan to visit this near term, after a clinical
>and/or ultrasonographic assessment of EFW, as well as a cervical
>examination.
>5. Have your partners deal with it :).
>6. Other: please expand
>
>Garry
>
>--
>Garry E. Siegel, M.D., F.A.C.O.G.
>Roswell, GA
>Private Practice
>
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