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Re: VBACFrom: D. Ashley Hill (dahmd@cfl.rr.com)Thu Dec 16 21:11:42 2004
At Thu, 16 Dec 2004, RModugno@aol.com wrote: > >1) Symptomatic uterine rupture occurred in 124 women who underwent a trial >of labor >(0.7 percent). > >2) Hypoxic–ischemic encephalopathy occurred in no infants >whose mothers underwent elective repeated cesarean delivery and in 12 >infants born at term whose mothers underwent a trial of labor (P<0.001). >Seven of these cases of hypoxic–ischemic encephalopathy followed u erine >rupture (absolute risk, 0.46 per 1000 women at term undergoing a trial >of labor), including two neonatal deaths. > >My questions are: 1)What are the medical-legal ramifications and 2)cost to >society of these cases of hypoxic-ishaemic encephalopathy. For the private >practioner, one case of uterine rupture with fetal compromise in this clim te >could be career-altering. This is exactly the reasoning why so many physicians in Florida (and I assume elsewhere) have stopped offering elective VBACs. One bad case and it's a hit. I wonder how many patients will tell their doctors that they agree to an elective repeat cesarean, then show up in labor hoping for a VBAC. Ashley
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency and Loch Haven Ob/Gyn Group Orlando, Florida
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