Re: Twins case part I
From: Daniel Flaherty (drdanf@earthlink.net)
Sun Apr 28 13:40:08 2002
Check out this month's editorial in Contemporary Ob/gyn advocating
abandoning forceps (only do vacuum) for delivery. No strong evidence.
Merely a CYA issue. It is a sad state of affairs, but the public believes
in perfect outcomes, and anything else is tougher to defend. Don't expect
the C/S rate to fall.
Dan Flaherty MD
>----- Original Message -----
From: "Joe Cutchin" <forcep@intercom.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
Sent: Sunday, April 28, 2002 9:26 AM
Subject: Re: Twins case part I
> Art: you are right on the money.My legal "friends?"constantly tell me that
> they do not influence the way we practice.BS.I think this case is a
classic
> example.You know ,I know ,hell everybody knows that vaginal delivery is
the
> route as there is no EBM to do otherwise.On the other hand if you have a
> problem then you are going to be sued.Why risk your career.Thats the
position
> of the younger obs now.A sad state of affairs.The legal profession at some
> point will have to develope some balls and stand up to this fact.Which
leads
> me to my pont. Obstetrics will be the first part of medicine socialized to
> take away the legal intrusion.Military has a good system.
>
> "art fougner, md" wrote:
>
> > 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
>
