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Re: CVA prior to pregnancy.From: ainsron (ainsron@sbcglobal.net)Mon Oct 16 10:41:52 2006
Thanks for your advice, I'm certainly leaning that way, I have scheduled a MFM consult and they can see her locally, even though she will have to travel for delivery. I will certainly sleep better knowing she is not hanging over my head. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Atkinson, Samuel M Sent: Monday, October 16, 2006 6:42 AM To: Multiple recipients of list OB-GYN-L Subject: Re: CVA prior to pregnancy. I have some sage advice. Get rid of her. Turn her over to the MFM's. Don't get trapped by "...it is a long way to drive to see one... or be delivered by one..." This lady is a time bomb. Hopefully George Burns (as in Oh God) is not in Africa hunting and the hoped for "miscarriage" will occur. At least God still does abortions. I left private practice over a Class D diabetic pregnancy that ended in stillbirth. I had encouraged high risk care. She demurred over the travel issue and egotistically I continued care, because I knew diabetes and the AirForce Base did not. In the suit, she testified that since I continued to provide care and see her, she had assumed everything was OK and she did not need a center to run estriols. No less than Steve Gabbe, current Dean at Vanderbilt testified in deposition as the expert for the defense. At least Jack Huddlestun came to my defense. Of course I never had my day in court with him as the Florida Bed Pan Mutual settled 20 different cases on a Friday to reduce their loss reserves. I could go on. You may argue she'll come in on your shift, etc. If she does, transfer her by helo if necessary. I suspect an attorney will tell you no informed consent will protect you unless you have him/her record the consent and have it signed and notarized in their office. As you can tell, it was a painful personal experience 25 years ago that led to major changes in my life that I still have not recovered from (as I face a stent in the right coronary tomorrow!) sAm Sam Atkinson,MD Professor, OB-GYN, Brody School of Medicine East Carolina University -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Ainsworth Sent: Friday, October 13, 2006 10:21 PM To: Multiple recipients of list OB-GYN-L Subject: CVA prior to pregnancy. I've recently acquired a NOB who had a CVA 2 1/2 months ago, she is currently 9wks pregnant and has residual left hemiparesis. She had been on coumadin, but her PCP changed her to Lovenox when the pregnancy was diagnosed two years ago. She is a type 2 diabetic, now on insulin since her CVA, her Hgb A1c in July was over 10, and hasn't been tested again since that time. She was on an ACE inhibitor and ASA which her PCP also discontinued. She is also AMA, 3 previous C/S and the list goes on and on. The obvious concern I have is her risk of recurrent CVA during this pregnancy. Does anyone have any astute advice or literature references that address this? I am scheduling her for a perinatal consult, sweet success program to assist with DM management and will discuss durable power of attorney with her (not TIC). She is not interested in termination of the pregnancy and says she understands the risk the pregnancy poses for her own health and life. I like challenges, but this could be hairy!
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