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Re: What's nextFrom: Efrain Ramirez (eramirezt@coqui.net)Thu Apr 24 21:16:23 2008
One of the reasons I presented this case was ACOGs' comments regarding this issue .. IMHO -- ACOG's wording has been awful... as you said – it’s a no win situation.. where EBM, experience and gut feeling can’t get together and reach an intelligent course of action as before.. nowadays you have to think from the outcome backwards- put your 20/20 eyeglasses and draw the course.. it’s madness.. Thanks for you thoughtful comments Ef At Thu, 24 Apr 2008, Charles Bloom wrote: > >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 >
-- "I can accept failure, but I can't accept not trying." - Michael Jordan
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