Re: What would you do?
From: Andrew Folley (agfolley@hotmail.com)
Fri Dec 29 20:14:39 2006
no I did not catch the 2 prior c-sections.
I would absolutely section her. agf
>From: eramirezt@coqui.net (Efrain Ramirez)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: What would you do?
>Date: Fri, 29 Dec 2006 18:00:52 -0600
>
>Andrew.. would you do the same thing in your setting even with this
>statement?
>
>Ef
>
>CLINICAL MANAGEMENT GUIDELINES FOR
>OBSTETRICIAN—GYNECOLOGISTS
>NUMBER 54, JULY 2004
>
>(Replaces Practice Bulletin Number 5, July 1999)
>
>What are contraindications for VBAC?
>
>A trial of labor is not recommended in patients at high risk for uterine
>rupture. Circumstances under which a trial of labor should not be
>attempted are as follows:
>Previous classical or T-shaped incision or extensive transfundal uterine
>surgery
>Previous uterine rupture
>Medical or obstetric complication that precludes vaginal delivery
>Inability to perform emergency cesarean delivery because of unavailable
>surgeon, anesthesia, sufficient staff, or facility
>Two prior uterine scars and no vaginal deliveries
>Should women with a previous cesarean delivery undergo induction or
>augmentation of labor?
>Spontaneous labor is more likely to result in a successful VBAC rather
>than labor induction or augmentation (52, 61, 62). A meta-analysis of
>studies published before 1989 found no relationship between the use of
>oxytocin and rupture of the uterine scar (83). In contrast, several
>more recent large studies have shown an increased risk (37, 61, 62, 84).
>In one large retrospective study of more than 20,000 women, uterine
>rupture was nearly 5 times more common among women undergoing labor
>induction with oxytocin compared with those who had an elective repeat
>cesarean delivery (37). However, uterine rupture occurred in less than
>1% of women in both groups. Furthermore, among the women attempting
>VBAC, the rate of uterine rupture was not different between those who
>received oxytocin and those who labored spontaneously.
>There is considerable evidence that cervical ripening with prostaglandin
>preparations increases the likelihood of uterine rupture (37, 61,
>85–87). In a review of Washington State birth records, the rate of
>uterine rupture during labor induced with prostaglandin was 24.5 in
>1,000, which was 15-fold higher than that of women electing to have a
>repeat cesarean delivery (37). Likewise, misoprostol has been
>associated with an unacceptably high rate of uterine rupture in women
>with a previous cesarean delivery (88–91). Therefore, the use of
>prostaglandins for induction of labor in most women with a previous
>cesarean delivery should be discouraged.
>
> At Fri, 29 Dec 2006, Andrew Folley wrote:
> >
> >Use of lovenox daily IM until 36 weeks. Switch over to heparin at that
> >time.
> >Plan vaginal birth. Consider induction and stop heaprin the night
>before.
> >Reheparinize 24 hour post partum and start coumadin for 6 months.
> >dc heparin when coumadin PT level 2-3x normal. Also recommend a
>greenfield
> >filter for her either now during the pregnacy or postartum.
> >
> >In addition do thrombophilia workup including homocystiene level, anti
> >phospholipids, lupus, ana
> >and typical antitrhombin 111 deficiency protein s and c etc.
> >
> >>From: Bernard Cristalli <bcrist@club-internet.fr>
> >>Reply-To: ob-gyn-l@obgyn.net
> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >>Subject: Re: What would you do?
> >>Date: Thu, 28 Dec 2006 08:04:17 -0600
> >>
> >>Then let the pregnancy go its normal way and discuss the way of delivery
>on
> >>time.
> >>A vaginal delivery would expose to a lesser risk than a CS. Lesser risk
>of
> >>hemorrhage and lesser risk of thrombo-embolic accidents.
> >>IMHO
> >>BC
> >>
> >>Dr Eberhard Lisse a écrit :
> >>>And then do what?
> >>>
> >>>el
> >>>
> >>>on 12/28/06 12:36 PM Bernard Cristalli said the following:
> >>>
> >>>>Wait till the cardio-pulmonary situation is stable.
> >>>>BC
> >>>>
> >
>
>--
>“ The greatest obstacle to knowledge is not ignorance,
>it is the illusion of knowledge.” Daniel J. Boorstin - Historian
