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Re: BreechFrom: ainsron (ainsron@sbcglobal.net)Wed Dec 15 16:27:56 2004
If she's really motivated and you can't do the version easily, try it with epidural or spinal. I did one like that and it worked well. I've never had a patient refuse a C/S when we've tried a version and failed, nor have I had a patient with a previous vaginal breech present with another vaginal breech. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod Darryl G MAJ 48 MDOS/SGOBO Sent: Wednesday, December 15, 2004 1:30 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Breech 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 48 MDOS/SGOBO UNIT 5210 Box 23 APO, AE 09464 DSN (314) 226-8334 Comm 01638-52-8334 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this Email and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This document may contain information covered under the Privacy Act, 5 USC 552(a), and/or the Health Insurance Portability and Accountability Act (PL 104-191) and its various implementing regulations and must be protected in accordance with those provisions. Healthcare information is personal and sensitive and must be treated accordingly. See <https://sg.usafe.af.mil/HIPAADisclosure.cfm> for full details. _____ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of ainsron Sent: Wednesday, December 15, 2004 12:25 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Breech Try version and if that fails, recommend cesarean section. If she declines have her sign informed refusal. Then offer C/S again when she comes in labor and have her sign informed refusal if she declines again. If you're lucky, your call associates will be on when she comes in, then they can share the grief. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod Darryl G MAJ 48 MDOS/SGOBO Sent: Tuesday, December 14, 2004 3:00 AM To: Multiple recipients of list OB-GYN-L Subject: Breech 32 yo G4P3 at 36wks and breech. First delivery was delivered breech after failed version. Next deliveries were vaginal without complications. She doesn't want a c/s and if the version fails this time she wants to deliver vaginally. In light of ACOG's stance on vaginal breech deliveries, how would you handle this situation? I'm personally inclined to let her attempt a vaginal breech delivery. She obviously has a proven pelvis. She understands the risk associated with delivering breech. Thanks, Glen D. Glen Elrod, Maj USAF, MC Obstetrician/Gynecologist Maternal Child Flight 48 MDOS/SGOBO UNIT 5210 Box 23 APO, AE 09464 DSN (314) 226-8334 Comm 01638-52-8334 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this Email and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This document may contain information covered under the Privacy Act, 5 USC 552(a), and/or the Health Insurance Portability and Accountability Act (PL 104-191) and its various implementing regulations and must be protected in accordance with those provisions. Healthcare information is personal and sensitive and must be treated accordingly. See <https://sg.usafe.af.mil/HIPAADisclosure.cfm> for full details.
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