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Re: breech From: Steve & Eryl Raymond (eryl@intekom.co.za) Thu Dec 16 12:38:08 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: VBAC" Previous message: Charlie Chambers: "Re: VBAC" In reply to: Dr Eberhard W Lisse: "Re: breech" Until one day you get a necrotising fasciitis or a DVT with Pulmonary embolus or a high spinal or secondary uterine sepsis with a vesico-cervical fistula, and you realise that it might have been an easy vaginal breech, but you never tried. All these things are rare, but when they happen they are easier to live with if you have good firm indications for the Caesar in the first place. This thread began with a case of a multip with a previous successful vaginal breech, keen to have a trial of labour, and I personally think that a case like that is exactly the sort that should be allowed a trial even if ECV under uterine relaxation after 37 weeks fails. Don't knock the "registrar's" opinion - it is beautifully reasoned, and from the little I have been learning this year in relation to randomised controlled trials, a perfect example of a design flaw as distinct from a statistical flaw. Steve Dr Eberhard W Lisse wrote: >Steve, > >In message <41C08E34.30105@intekom.co.za>, Steve & Eryl Raymond writes: > >>There should be no argument about the invalidity of the Hannah "term >>breech trial" now. I thought everyone had seen through it long ago >>and that the criticism in the BMJ of October 30th had laid it to rest. >>Eberhard, if you didn't see it read it at: >>http://bmj.com/cgi/content/full/329/7473/1039?etoc >> > >This is one opinion. Of a registrar. > >>I'll state it categorically now - there is no evidence that vaginal >>breech delivery is in itself any more dangerous than a Caesarean >>section in a properly selected patient. It may be intuitive and there >>may be anecdotal evidence, but there is no EVIDENCE. >> > >If I don't understand this wrongly, Hannah said, the less experienced >you are the more dangerous it is. Kotaska's opinion holds, the more >experienced you are the less dangerous it is. > >Hmmm :-)-O > >I may concede, that in expert hands, a breech delivery may, perhaps, >still be attempted, but we are Men of Steel here, not experts. > >I have done ton's of breeches at the State, but I think it is just not >worth the risk. I just do the Vaginal Bypass and everyone is happy. > >el > Next message: art fougner, md: "Re: VBAC" Previous message: Charlie Chambers: "Re: VBAC" In reply to: Dr Eberhard W Lisse: "Re: breech"

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