Re: Shoulder dystocia - Again!
From: Anna Meenan, MD (annam@uic.edu)
Sat Sep 18 22:25:07 2004
Ooops, forgot a couple of points. Follow up on even a SINGLE abnormal
glucose reading? Do we have ANY evidence that anything we do to or for
gestational diabetics (as opposed to pre-existing diabetics) improves
any outcome? Yes, I know we do it anyway, but let's not get paranoid
about single readings in patients who don't fulfill the definition af
gestational diabetes if we can't even prove we are making a difference
in the outcomes of the gestational diabetics.
And, consider c-section for anyone who expresses fear or doubt about
vaginal delivery? Let's just section EVERYONE then.
--
Anna Meenan, MD
At Sat, 18 Sep 2004, Anna Meenan, MD wrote:
>
>Interesting. Most of the recommendations for prediction and prevention
>are not supported by evidence-based medicine, and following them would
>result in thousands of unnecessary c-sections, likely leading to some
>maternal deats to prevent Erb's Palsies. The only author I have seen
>seriously try to convince anyone that shoulder dystocias can be safely
>predicted and prevented is James O'Leary, whose son is a personal injury
>lawyer who specializes in damaged babies. I believe that the ACOG
>technical bulletin on Shoulder Dystocia recommends that elective
>c-section be CONSIDERED in diabetic moms with EFW greater than 4500g
>(NOT 4000), and does not recommend elective c-section at any EFW in
>non-diabetic moms. (My technical bulletins are at the office and I am
>at home). And of course, EFW's are not even accurate to begin with, the
>most accurate being those estimated by multiparous moms on the babies
>they are carrying.
>
>I find it fascinating that we are now being recommended to subject
>newborns to a week of daily EMG's just to make the lawyers happy.
>
>I DO agree with the recommendation to write a delivery note that
>carefully documents the use of an orderly series of recommended
>maneuvers in delivery of the shoulders, and I do agree with involving
>pediatric specialists IMMEDIATELY in any case of brachial plexus palsy.
>
>No, we don't do shoulder dystocia drills in our hospital. In cases
>where there are risk factors, I review the HELPERR mnemonic with the
>resident before the delivery and make sure the nurse marks delivery of
>the head on the monitor strip. Of course many shoulder dystocias occur
>in normal-weight babies with no risk factors, so there you are.
>
>--
> Anna Meenan, MD
>
>At Sat, 18 Sep 2004, RModugno@aol.com wrote:
>>
>>This month's OBG management had interesting recommendations on shoulder dystocia:
>>
>>http://www.obgmanagement.com/content/2004/09/tables/078/sidebar_03.pdf
>>
>>Does anyone do shoulder dystocia drills or have a "shoulder dystocia" team, like a "code blue" team at their hospital?
>>
>>Robert Modugno MD MBA FACOG
>>Marietta, GA
>>http://www.novaobgyn.yourmd.com
>
