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Re: BreechFrom: Henry Gregor (henrygregor@yahoo.com)Tue Dec 14 16:09:41 2004
I would protect your future ability to practice obstetrics w/o stress and distraction of depositions by insuring patient's situation conforms to the published (multiple times, multiple places) criteria for trial of breech vaginal delivery, such as: nonstargazer, what type breech presentation, pelvimetry assessment (only really clinically effective assessment ... google Friedman, or Henry Klaphotz, and Ball pelvimetry. Both published computer algorithms for calculating fetal and pelvic compartmental volumes, and updates to MRI data as opposed to xray data have been done.), be explicit prior clinical pelvic trial won't necessarily convey assurance with another fetus, even one of lesser weight, might reference fact that even in appropriately selected trial breech labors there is a bottom line incidence of intrapartum fetal/neonatal injury (Survey of Obstetrics and Gynecology did a great comprehensive review of this some years ago.)....patient autonomy dictates patient's right to make informed choices, though you need to document, document, document...I know, sounds like the liability insuror's risk management director. And, what's the patient's attitude and plan re intrapartum situations which might lead to recommendations for C/S then? I think the patient has a prerogative to go the route she wishes, and in a better world of patient physician interaction, all this obsessing with documentation etc. would ideally not be required....but we're not in that world. Hank "art fougner, md" <evsono@pipeline.com> wrote: a minefield to be sure ... even Hannah's group admits that the longer follow-up suggests little difference in childhood development, assuming no mishaps during the birth process occur ... and there-in lies the rub.
At Tue, 14 Dec 2004, Elrod Darryl G MAJ 48 MDOS/SGOBO wrote:
>
-- art fougner, md ich bin ein New Yorker
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