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Re: cerclage patient From: Jafar6 (jafar6@optonline.net) Wed Jul 2 16:39:02 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Lynn D. Montgomery, M.D.: "Re: Two OB questions" Previous message: Braun, R. Daniel: "Re: Two OB questions" In reply to: Lynn D. Montgomery, M.D.: "Re: cerclage patient" on 7/2/03 3:44 PM, Lynn D. Montgomery, M.D. at apgar10@montanadsl.net wrote: > Gary, > First, there is a provision for doing a tubal on a patient when delivery > occurs prior to the EDC - under emergency circumstances. It's partially our fault. We did not bring up the issue since the patient had only one living child and the prognosis for the current pregnancy was guarded. When the patient requested a tubal, it was at the time of delivery. There is no provision in the law for that. Signing the consent 3 days before would have been acceptable. > Second, but most importantly, you have been placed in a "no win" > situation by the referral doc. To repeatedly attempt a vaginal cerclage > in a patient who has failed before is very poor judgment on his/her > part. I am so glad that others agree with this assessment. There is moderately good evidence that an abdominal cerclage may be effective after failed vaginal cerclages. There is very little in the literature regarding "emergent or rescue" abdominal cerclages. I am not sure that this patient had incompetent cervix prior to her cerclages and partial cervical amputation. She may have other factors (PTL, predisposition to infection, etc) that might make an abdominal cerclage ineffective. Since she has significant centripetal obesity and possible adhesions from her vertical cesarean, I am leery to subject her to this procedure, but it may be a reasonable choice. > > This is a case of "if we don't police ourselves, then how can we > complain when others do" (lawyers for instance). That said, I would be > very tempted to enlighten this patient about her care prior to transfer > of care... The suggestion has come up. I informed the patient that our group might not be able to help her. I will ask that this case be presented to hospital Q/A at my hospital and the referring hospital. Your suggestions are greatly appreciated, but disparaging the physician's actions to the patient would be a risky action. > Lynn > I really appreciate the response and could really use more advice and assistance. Will contact the perinatal group at Yale-New Haven, down the road, for their opinions and help. Gary Kleinman (BTW Rich, Las Vegas also has Debbie Gold and Josef Zority. Can't lose with them. Will look on the med society page to make sure I miss no one!) Next message: Lynn D. Montgomery, M.D.: "Re: Two OB questions" Previous message: Braun, R. Daniel: "Re: Two OB questions" In reply to: Lynn D. Montgomery, M.D.: "Re: cerclage patient"

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