Re: April fools' marginal placenta previa.
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Apr 3 15:36:34 2007
Note that these were all TRANSVAGINAL exams. I bet that not more than 20% of
ultrasonographers in the USA would even consider doing such an exam on a
patient who was bleeding.
Dan
On 4/2/07, art fougner, md <evsono@pipeline.com> wrote:
>
> Placental edge to internal os distance in the late third trimester and
> mode of delivery in placenta praevia
>
> * Amarnath Bhide,
> * Federico Prefumo**Dr F. Prefumo, Fetal Medicine Unit, St George's
> Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK.,
> * Jessica Moore,
> * Brian Hollis,
> * Basky Thilaganathan
>
> *
> aFetal Medicine Unit, Academic Department of Obstetrics and Gynaecology,
> St George's Hospital Medical School, London, UK
>
> *Dr F. Prefumo, Fetal Medicine Unit, St George's Hospital Medical
> School, Cranmer Terrace, London SW17 ORE, UK.
> Abstract
>
> Objectives To correlate transvaginal ultrasound findings with mode of
> delivery in cases of placenta praevia.
>
> Design Cohort study.
>
> Setting A London Teaching Hospital.
>
> Methods Retrospective review of all cases of placenta praevia diagnosed
> by transvaginal ultrasound between February 1997 and March 2002.
>
> Main outcome measures Likelihood of vaginal delivery and major obstetric
> haemorrhage.
>
> Results A total of 121 pregnancies were studied with a mean
> scan-to-delivery interval of 10.5 days. In the 64 women who laboured,
> the likelihood of vaginal delivery rose significantly as the placental
> edge to internal os distance increased. Caesarean section rate was 90%
> when the placental edge–internal os distance was 0.1 to 2.0 cm, falling
> to 37% when this measurement was over 2.0 cm (P< 0.00045).
>
> Conclusion Trial of vaginal delivery is appropriate in cases with a
> placental to internal os distance>2 cm. The term 'praevia' should be
> restricted to cases where the placental edge is ≤2 cm from the
> internal os, as the likelihood of operative delivery and significant
> postpartum haemorrhage is high. Cases where the placenta is more than 2
> cm from the internal os have a greater than 60% chance of vaginal
> delivery and should be defined as 'low lying' in order to reduce the
> clinician's bias towards operative delivery.
>
> Art
>
> At Mon, 2 Apr 2007, R. Daniel Braun wrote:
> >
> >I bet someone of "Stature" said "Gee, I think if it isn't at least 3 cm
> >away, it could bleed a lot." And hence it has been so ever since.
> >Dan
> >
> >On 4/2/07, ainsron <ainsron@sbcglobal.net> wrote:
> >>
> >> What is their rationale for a 2cm cutoff??
> >>
> >> Ronald E. Ainsworth, MD, FACOG
> >>
> >> -----Original Message-----
> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
> E.
> >> Siegel, M.D.
> >> Sent: Monday, April 02, 2007 9:52 AM
> >> To: Multiple recipients of list OB-GYN-L
> >> Subject: Re: April fools' marginal placenta previa.
> >>
> >> FWIW, our MFMs quote 2 cm. as the cutoff for allowing a vaginal
> >> delivery.
> >>
> >> Recently saw a scan on a CNM patient, 37 weeks, 9 to 12 mm from the os,
> >> posterior placenta, previous vaginal delivery then LTC/S for breech.
> >>
> >> I got this scan on Friday at 3 PM, called her, and advised a section
> >> this week or if labors, and explained why. And I quote, "The midwife
> >> said it was OK." I told her that I was the obstetrician, and, well, my
> >> opinion was the senior one in this instance and that she was mistaken.
> >>
> >> She did not like my advice, and who knows what will happen when she
> >> comes in this week to see the CNM.
> >>
> >> Garry
> >>
> >> At Mon, 2 Apr 2007, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.
> >> wrote:
> >> >
> >> >At Sun, 1 Apr 2007, R. Daniel Braun wrote:
> >> >>
> >> >>Double Setup WHY???????????????????
> >> >>Just cut.
> >> >>Dan
> >> >>
> >> >The patient was expecting a nice midwife no intervention birth and
> >> >really did not want to have c-section; after the double setup I could
> >> >honestly tell her sorry that will not happen today.
> >> >
> >> >--
> >> > Take care, John
> >> >
> >>
> >> --
> >> Garry E. Siegel, M.D.
> >> Private Practice
> >> Roswell, GA
> >>
> >--
> >R. Daniel Braun, MD FACOG(L) CMT
> >Professor Emeritus
> >Dept. of Obstetrics and Gynecology
> >Indiana U. School of Medicine
> >
> >R. Daniel Braun
> >
> > "The way to health is an aromatic bath and scented massage
> everyday".
> > Hippocrates
> >
>
> --
> art fougner, md
> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
--
R. Daniel Braun
"The way to health is an aromatic bath and scented massage everyday"..
Hippocrates
