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Re: OB: How to deliver From: Efrain Ramirez (eramirez@icepr.com) Wed Jan 30 14:59:42 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Kevin Dew: "Re: Cytotec for IUFD" Previous message: art fougner, md: "Re: OB: How to deliver" In reply to: Garry Siegel: "OB: How to deliver" Next in thread: Steve & Eryl Raymond: "Re: OB: How to deliver" Wait until term - do EFW clinically (ask Mom also) and by U/S - do GTT - she has an incrteased risk to repeat SD - good informed consent - for either vaginal or abdominal delivery... TI- Recurrence rate of shoulder dystocia. AU- Lewis DF; Raymond RC; Perkins MB; Brooks GG; Heymann AR AD- Department of Obstetrics and Gynecology, Louisiana State University Medical Center, Shreveport 71130-3932, USA. SR- Am J Obstet Gynecol, 172:1369-71, 1995 May AB- OBJECTIVE: Shoulder dystocia continues to be a major complication of obstetrics, and several factors have been identified to help predict its occurrence. A previous shoulder dystocia is one of the risk factors. However, the recurrence rate is unknown. The purpose of this study is to report the recurrence rate of shoulder dystocia. STUDY DESIGN: Our obstetric database was used to identify all vaginal deliveries between January 1983 through December 1992. A subset of vaginal deliveries complicated by shoulder dystocia was selected from this database. These records were reviewed to identify subsequent pregnancies, outcomes, risk factors, and demographic data. RESULTS: During the study period there were 37,465 total vaginal deliveries, with shoulder dystocia complicating 747 (overall rate 2%). Of these 747 cases, 101 patients had 123 subsequent vaginal deliveries, with shoulder dystocia complicating 17 of these pregnancies (13.8% recurrence rate, p < 0.0001). Comparisons were made between those patients with recurrent shoulder dystocia. CONCLUSION: Shoulder dystocia recurred at a rate approximately seven times higher than our primary rate. Whether patients with a history of shoulder dystocia should be offered an elective abdominal delivery requires further investigation. Fetal Macrosomia CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN—GYNECOLOGISTS NUMBER 22, NOVEMBER 2000 (Replaces Technical Bulletin Number 159, September 1991) Summary The following recommendation is based on good and consistent scientific evidence (Level A): The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers). The following recommendations are based on limited or inconsistent scientific evidence (Level B): Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes. With an estimated fetal weight greater than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. The following recommendations are based primarily on consensus and expert opinion (Level C): Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights greater than 5,000 g in women without diabetes and greater than 4,500 g in women with diabetes. Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery. Good luck Garry - Efrain At Tue, 29 Jan 2002, Garry Siegel wrote: > >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 > -- "Life is neither the notes nor the silence between the notes, but the music that arises out of sound and silence felt as a living whole. Stop choosing...between chaos and order, and live at the boundary between them, where rest and action move together..." David Whyte Next message: Kevin Dew: "Re: Cytotec for IUFD" Previous message: art fougner, md: "Re: OB: How to deliver" In reply to: Garry Siegel: "OB: How to deliver" Next in thread: Steve & Eryl Raymond: "Re: OB: How to deliver"

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