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Re: What's next From: Charles Bloom (cdsb@bellsouth.net) Thu Apr 24 06:44:52 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Cesar Molina: "Re: In-office ablation video" Previous message: Charles Bloom: "Re: What's next" In reply to: Laureano Folgar: "Re: What's next" This case is a perfect example of one of the many frequent and challenging conundrums we face in medicine. To answer your question, there is no way to prevent litigation in the US, only to increase your chances of prevailing. ACOG’s statement I believe was to address the very issue presented by this case. Prior to that, it was very unlikely for you to be sued for premature delivery if there was any intrauterine fetal compromise. You mostly got sued for damaged or dead babies. The problem is that now we are stuck walking a tightrope and frequently there is no possible good outcome. As an example, if we somehow knew that an IUGR fetus was going to suffer hypoxic brain injury at 32 weeks (of course there is no way we could know this precisely in advance), we would have been forced to deliver before that and the fetus would be in the NICU for a long time and possibly have residual long term effects. If we deliver too late, it’s an easy malpractice suit. Now, if we could even miraculously manage to deliver the day before the fetus suffered permanent neurological damage, there would be no way to prove that it was at the last possible moment and we run the risk of being accused of delivering too early. A no win situation. And as you said, informed consent is very helpful here, if for no other reason than to involve the family in the medical plan. I think the best we can do is frequent testing and deliver at the first sign of demonstrable fetal compromise by any of the testing parameters we’re using or at the EGA we feel will not pose a prematurity risk if the testing remains perfect. -- Charles Bloom, MD http://www.smartob.com -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Laureano Folgar Sent: Thursday, April 24, 2008 7:09 AM To: Multiple recipients of list OB-GYN-L Subject: Re: What's next As Dan said, that is the late preterms we are talking about. The "state or art" is an hemodynamic strictly follow up till term or suspected foetal compromised. The "litigation fear recommendation" is cs now. So, is "litigation fear recommendation" a good reason as ACOG recommended?. I´m not familiarized with US laws, but a well informed consent clearly reported in the clinical history, does not avoid a litigation?. L. Folgar. Efrain Ramirez escribió: > No fetal weight gain at all in the last 2 weeks.. umbilical artery > doppler normal.. MCA not done.. mother perceives fewer FM's.. just > like the other pregnancy. > Definitive asymmetric IUGR. > Level III NICU .. I had to deliver in the last year to babies at 26 > weeks .. doing well.. > Steroids? – it’s a Democratic Primary.. > Legally speaking an unexpected IUFD would be hard to defend... NICU > complications, IMHO, easier. > Thanks to all.. recommendations well taken… > > Ef Next message: Cesar Molina: "Re: In-office ablation video" Previous message: Charles Bloom: "Re: What's next" In reply to: Laureano Folgar: "Re: What's next"

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