Re: OB: 31 week IUFD
From: art fougner, md (evsono@pipeline.com)
Fri Mar 19 18:25:00 2004
Ultimately, the only peer whose opinion counts is the face looking back
at you in the mirror every day.
art
At Fri, 19 Mar 2004, Brickster0@aol.com wrote:
>
>You can only have placenta accreta if you still have a uterus. Can you quote
>me the risk of inducing (or waiting for spontaneous labor) in someone with 2
>previous sections with an undocumented scar? My office is 5 miles from Gary's
>and in this area an undocumented scar usually means Mexican, and in my
>experience (anecdotal) they frequently have peritoneal windows where the lower
>uterine segment used to be. The risk of accreta is still less than uterine rupture.
>
>This is an argument I frequently see from people who are not directly
>responsible for the outcome. If a mother or child dies under my care, it is my
>responsibility. It hopefully is not my fault. Today a 5:00am I sectioned a
>G3P1011 at term for painless vaginal bleeding that awoke her from sleep. Fetal
>tracing reassuring. In my residency, (or in my community; Kaiser) She would be
>induced until the stuff hit the fan. Frequently the stuff would never hit the
>fan, but just as often it will. There are no studies to prove or disprove this
>(by the way both Gary and I can add several suffixes to our names; usually a
>sign of someone who needs to prove something). She had a 70% abruption with
>1000cc in her uterus; so I'm glad I did the section, but if she was completely
>normal I still have a healthy mother and daughter. I've taken care of her for
>5yrs. I delivered her first, did her elective D&C when she miscarried, and
>helped her through a minor infertility problem. Until you attend someone's
>funeral for whom you are responsible you should "keep your mouth shut and be
>thought a fool instead of opening it and removing all doubt."
>
>Brick Bills, MD, BS, Bachelor Engineering Science, & BMF
>(my apologizes in advance, especially to Gary, I hope your weekend is
>uneventful; Gary sectioned a pt of my who died of a cerebral aneurysm and I still
>take care of the rest of her family members)
>
>In a message dated 3/19/2004 11:46:08 AM Eastern Standard Time,
>valjacobsen@yahoo.com writes:
>>Maybe I misread the initial post. Are you laboring (spontaneous or not), two
>>prev c/s with unknown scars? The best outcome is a vaginal delivery of a
>dead
>>baby at some unknown time and date (300AM or in the middle of office hours).
>>The worse is a ruptured uterus and a hysterectomy. If my junior partner
>>offered this laboring this pt, I will tell him to call our insurance
>carriers risk management. She should at least be offered the choice of repeat
>section.
>>Personally I would cut her as soon as she is emotionally ready.
>
>Why increase her risk of accreta for a dead baby, I wonder.
>
>(Mankuta, AJOG, Sept. 2003)
>
>Valerie Jacobsen, RN, BSN, MS
--
art fougner, md
ich bin ein New Yorker
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