Re: OB: How to deliver
From: Garry Siegel (garrys@mindspring.com)
Wed Jan 30 21:20:40 2002
Steve:
I think that is kind of like #4, I suppose--plan a section near term,
but assess things beforehand.
I will likely propose that, but will have a low threshold to do a
section. If she balks one millimeter at the thought of a vaginal
delivery, right or wrong, then she's a section.
Garry
At Wed, 30 Jan 2002, Steve & Eryl Raymond wrote:
>
>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
>
--
Garry E. Siegel, M.D., F.A.C.O.G.
Roswell, GA
Private Practice
