Re: OB: How to deliver

From: Steve & Eryl Raymond (eryl@intekom.co.za)
Wed Jan 30 20:27:04 2002

I'm advocating No.6: You can't make this decision until she is nearing term and you get some idea of an estimated fetal weight. What if this one is a kilogram lighter? Booking an elective C/S now and leaving yourself no "out" if she goes into labour at 36 weeks and delivers easily would be a mistake. Tell her you are leaning towards a very low threshhold for Caesar unless there are obvious reasons to expect no trouble in labour. I.e. "suck it and see". stray

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

--


Dr.S.H. Raymond
Head of Department of O & G
Empangeni Hospital
South Africa 3880
Phone: (+27) 35-7721111
Fax: (+27) 35-7922596



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