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Re: VBACFrom: ainsron (ainsron@sbcglobal.net)Thu Dec 16 19:31:24 2004
If you read much about HIE, you know that 90% of HIE is caused by factors unaffected by labor ("It was estimated that in only 8% (15/183) of all the children with spastic cerebral palsy was intrapartum asphyxia the possible cause of their brain damage." Blair & Stanley, J Pediatr (1988)112:515) - infection, bleeding disorders, hypothyroidism, prematurity, multiple gestation, etc. That is why labor management over the past three decades has resulted in an increasing C/S rate without lowering the rate of cerebral palsy. In this study, they looked only at term singleton pregnancies, therefore, only a small subset of patients at risk of HIE. Per the Australian Case Control Study: 70% of NIE had no evidence of intrapartum hypoxia 4% of moderate to severe NIE had intrapartum hypoxia 25% of cases of intrapartum hypoxia superimposed on preexisting insults. This article correlates interestingly with the predictions of Nelson regarding prevention of CP by cesarean section for fetal distress (NJM, 1996; 334:613): Based on multiple lates or persistent decreased BTB variability, 500 C/S are required to prevent one case of CP. However as a result, you risk: * Future uterine rupture rate 0.5% =2.5 ruptures * 40% risk of neonatal death or CP * Future risk of previa and acreta 10-20 x RR * Excess maternal risk of cesarean * EBL doubled * Infection 5-10 x RR * DVT/PE 5 x RR Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of DoctorJoe@aol.com Sent: Thursday, December 16, 2004 5:42 PM To: Multiple recipients of list OB-GYN-L Subject: Re: VBAC Well, the FIRST thing is - make sure you have the causation down. Are you saying that NO HIE can be caused by vaginal delivery and in cases of HIE, if you HADN'T done a VBAC you wouldn't have been "burned?" Joe P.
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