|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: Sometimes breeches are just meant to be born vaginally.From: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Fri May 30 04:56:10 2008
At Fri, 30 May 2008, Dr. Bülent Potur wrote: > >Two experiences reminding Murphy: >1) Complete effacement and dilatation. Frank breech. Primiparous (second delivery) patient. Encouragement of the patient to bear down. Occasional fhr deceleration. And then an abrupt terminal fetal bradicardia. Vaginal extraction and delivery. Cord wrapped four times around the neck. So this caused a very short cord. >2) a 69 twin 9 coming first.Then locked twins. > >Me and my peers had some older brother (assistant professor) when we were being trained in the teaching hospital who would ask "Haven't you ever delivered primigravida breeches?" when we were trying to section. So we had in deed delivered some primigravida breeches during residency with no adverse outcomes. So when a specialist I would section primigravida breeches and allow the midwives to perform delivery of multipara breeches. >Above, The first example was my personal experience more than a decade ago. In the second I was the Obgyn on call, the experience was of a midwife. >Nowadays if not imminently delivering I tend to section all breeches. >Greetings from Türkiye. >Bülent Potur > Greetings and thankyou for posting your experiences. Your case 1. Hard to believe there where no variable deccels prior to pushing, how long was the active 2nd stage, how low was the sacrum when you first got MoM to start pushing. In my case active 2nd stage was less than 2 minutes and sacrum was at +5. Case 2. I never labour twins when prsenting twin is not a well applied vertex for just this reason. I have only done about 100 non-twin breach delieveries and obviously most of these where before 2000. In my limitted experience the sweet spot for vaginal frank breach delieveries was 32-36 wks gestation. I have had more difficult multip vag breach delieveries than primip Vag breach delieveries. Prior to the term breach trial when I was doing trials of labor for breaches my c-section rate for breachs was 50%, I was not a risk taker and I did augement labor when necessary.
--
Take care, John
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Sat Aug 2 04:55:29 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.