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Re: BreechFrom: RModugno@aol.comWed Dec 15 13:45:37 2004
In a message dated 12/15/2004 4:30:10 AM Eastern Standard Time, Darryl.elrod@LAKENHEATH.AF.MIL writes: It looks like I’m nearly alone on this issue. The others either would not labor her or don’t want to labor her without some assistance, presumably from me. I’m not sure why I have such heartburn about sectioning her. If it were her first or second pregnancy I’d do it without batting an eye. If she hadn’t already delivered a breech I’d probably still not have any problem. In looking at studies like the Term Breech Trial and talking to one of my partners that enrolled pts during residency in that trial it doesn’t look like prior breech delivery fell into anything studied. I would assume that women who had already done it once wouldn’t want to be randomized and possibly get a section. I would bet that if her version fails tomorrow that we would send her off to the British system for an attempted vaginal breech delivery since few are comfortable here doing it. Its sad for me that we can pawn off our potential medicolegal problems on another system but it is the reality of our constructs. (we also send off VBACs) Glen D. Glen Elrod, Maj USAF, MC Obstetrician/Gynecologist Maternal Child Flight I would not feel that uncomfortable delivering this patient - given her past history of successful vaginal breech delivery, if the baby is not macrosomic, if it's a frank breech without a hyperextended head, plenty of informed consent and a trigger finger on the scalpel during labor. If you do a section - it would be nice to know whether she has a septate uterus or something. Robert Modugno MD MBA FACOG Marietta, GA http://www.novaobgyn.yourmd.com
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