Re: Twins case part I
From: art fougner, md (evsono@pipeline.com)
Sun Apr 28 09:09:01 2002
convene a panel of local med mal plaintiff's attorneys for a pro-active
legal opinion - you may as well hear the bad news before the fact. (TIC)
art
At Sun, 28 Apr 2002, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
wrote:
>
>This is a bread and butter twins case, I guess some of you will find
>this
>boring, but just think its only a matter of time before a multicenter
>randomised
>clincal trial is done comparing elective c-section at term for twins Vs.
>a trial of labour(I tought I heard one was in the works somewhere). I
>think any such trial will almost certainly mirror the results of the
>Canadian multicenter
>term breach trial, that being that overall c-section will be found
>safer(for the babies). Anyway here goes...
>
>I am on call for the hospital and have just finished an easy
>straightfoward delievery when I get a call from a family Doctor who
>works in a local hamlet
>about 80 mi from our center. He would like to transfer a 34 y.o. G3 P2
>mom with
>twins at just under 35 wks , he is afraid mom is going into labour and
>the local
>hospital's nursury doesn't feel comfortable taking care of 35 wk twins.
>Family
>Doctor says Mom is 4cm dialated,80 % eff. stx -1 and contractiong every
>4 minutes. Mom
>had an ultrasound on that day which shows twins are vertex/vertex, there
>are
>two sacs(thank God!), twins are apropriate for 34-35 wks but twin B is
>about
>20 % smaller than Twin A. Mom's last labour had a first stage of 3 hrs
>and a
>second stage of less than 20 min for an 7 lbs baby. It's just before
>midnight
>and he's going to send mom over by air ambulance, it sounds like he is
>not
>convinced mom is in active labour, he doesn't ask about tocolysis and I
>do not
>tell him he must start tocolysis . Mom and Dad get to our hospital just
>after
>1 am , I say hello to them very pleasant and reasnable couple. Almost
>by instinct the D.R. staff have straped on the EFM. EFM shows very
>nice tracing
>for both twins and contractions every 3-4 min. I examine patient the
>results are
>about the same as family doctors last exam, I palpate a couple of
>contractions
>and they are not to impressive, mom says she can feel them but not
>painfull. D.R. staff ask about calling in the anaesthist for epidural,
>I tell staff I
>don't think mom is in active labour yet. I ponder giving Mom some
>betamethasone
>(celestone),but instead tell Mom to try and get some sleep because
>that's what I
>plan to do!
>So here is the Question for part II, its 2.5 wks latter and sitting on
>my hands
>seems to have caused Mom and twins no ill effects. So should I book an
>elective
>c-section at 38 wks, book an elective induction on quiet day where I
>plan to have anaesthist and pediatrician present, or should I throw all
>caution to the wind and just hope anaesthist and peds are readily
>available when Mom goes into labour ?
> Take care, John
--
art fougner, md
ich bin ein New Yorker
