OB-GYN-L Messages for July, 2003: Re: OB: Bladder Flap

Re: OB: Bladder Flap

From: Anna Meenan, MD

annam@uic.edu

Tue Jul 15 21:55:20 2003

Posterior arm much easier in all-fours.

-- Anna Meenan, MD

At Tue, 15 Jul 2003, Terrence.Jones@kp.org wrote: > >This is a multipart message in MIME format. >--=_alternative 0003BD0588256D65 Content-Type: text/plain; charset="iso-8859-1" >Content-Transfer-Encoding: quoted-printable > >Hmm. I'd think Mats' recent classification of "litterature", and His >former "Eminence-based Medicine" are 'profound'. So enlighten us, Joe. >Your nullip with suspected macrosomia (based on abnl GTT, wt gain, >obesity, and clinical assessment) has now been pushing 3.5 hrs with her >epidural and 'adequate uterine contractions' (defined in any way you'd >like). There is separation of the introitus with ctxs, but not in between. >There is 3 cm caput, and the BPD is at the spines. There has been >noticeably little progress in the past hour, and exhaustion is looming. A >c/s is decided upon. You're in the peritoneal cavity, and palpate the >baby's shoulder below the intended site of the bladder flap. Now, take us >the rest of the way (carefully). I'm listening intently. As Bernard's >suggestion of retrograde filling of the bladder with cord prolapse DOES >change acuity. And tho, so far, more comfortable with the posterior arm in >dystocia, Anna's "all-fours" is always in the back of my mind. Tell us how >you proceed. And if time permits, how you decide (what clinical features >determine) which 'profound truth' to follow. tj > >DoctorJoe@aol.com >Sent by: ob-gyn-l@obgyn.net >07/13/2003 02:32 PM >Please respond to ob-gyn-l > > To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.n t> > cc: > Subject: Re: OB: Bladder Flap > >In a message dated 7/13/03 10:07:38, eramirezt@coqui.net writes: > >IMHO the best way is for an assistant to push the presenting part >upwards - > >Yes, and as they say, > >"The opposite of a correct statement is a false statement. >But the opposite of a profound truth may well be another profound truth." > >Niels Bohr (1885 - 1962) > >Joe P. > >--=_alternative 0003BD0588256D65 Content-Type: text/html; charset="iso-8859-1" >Content-Transfer-Encoding: quoted-printable > > Hmm. I'd think Mats' recent classif cation of "litterature", and His former "Eminence-based Med cine" are 'profound'. So enlighten us, Joe. Your nullip with suspecte macrosomia (based on abnl GTT, wt gain, obesity, and clinical assessment) has now been pushing 3.5 hrs with her epidural and 'adequate uterine contr ctions' (defined in any way you'd like). There is separation of the introi us with ctxs, but not in between. There is 3 cm caput, and the BPD is at t e spines. There has been noticeably little progress in the past hour, and xhaustion is looming. A c/s is decided upon. You're in the peritoneal cavi y, and palpate the baby's shoulder below the intended site of the bladder lap. Now, take us the rest of the way (carefully). I'm listening intently. As Bernard's suggestion of retrograde filling of the bladder with cord pro apse DOES change acuity. And tho, so far, more comfortable with the poster or arm in dystocia, Anna's "all-fours" is always in the back of y mind. Tell us how you proceed. And if time permits, how you decide (what clinical features determine) which 'profound truth' to follow. tj > ><table width0%> ><tr valign=top> ><td> ><td>DoctorJoe@aol.com > Sent by: ob-gyn-l@obgyn.net >07/13/2003 02:32 PM > Please respond to ob-gyn-l > ><td>        >         To: &nb p;      Multiple recipients of list OB-GYN-L <ob-gyn-l@d s.obgyn.net> >         cc: &nb p;       >         Subject        Re:  OB: Bladder Flap</table> > > >In a message dated 7/13/03 10:07:38, eramirezt@coqui.net writes: > > > IMHO the best way is for an as istant to push the presenting part >upwards - > > > >Yes, and as they say, > >"The opposite of a correct statement is a false statement. >But the opposite of a profound truth may well be another profound truth.&q ot; > >Niels Bohr (1885 - 1962) > >Joe P. > > >

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