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Re: induction of breech at termFrom: =?utf-8?B?RHIuIELDvGxlbnQgUG90dXI=?= (bpotur@yahoo.com)Wed May 20 15:32:13 2009
Fifteen years ago I have been there in a worse awful one. Complete dilatation breech on the perineum for about half an hour.It does not progress with patient's push then on auscultation terminal fetal bradycardia was dicovered. The emergent breech extraction and delivery was a tedious one. Upon delivery it was discovered that the remaining cord was short and tight after encircling tightly the fetus's neck three or four times. So yes the fetus had been really hung by the birth.The recussitation had only provided heart beats which were also lost during transport to a tertiary center.  On the other hand years ago I had also an awful case of beech cesarean. At that time the team would not be on duty. Nurses and anestesia tecnicians would be collected from their homes at 3 am. So when started the breech had descended considerably. Lower transverse uterine incision extended deep in the vagina on the left side. There was very heavy bleeding  from multiple points which flooded the operative site. At that hour a urologist was not available. So the patient was well and alive on 1st post operative day. But on 3 day urine was discharging from the vagina. There was a uretero vaginal fistula. Which healed with a urologic intervention by inserting a a double J catheter .Bulent --- 20/05/09 Çar tarihinde R. Daniel Braun <rd.braun@gmail.com> şöyle yazıyor: Kimden: R. Daniel Braun <rd.braun@gmail.com> Konu: Re: induction of breech at term Kime: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net> Tarihi: 20 Mayıs 2009 Çarşamba, 22:49 The only "Simply Awful" breech that I had in my 40+ yrs of delivering babies was a patient who presented with the buttocks visible on the perineum(Rumping??) after a 4 hour labor. Everything went fine until the head got hung up. Apgar 1-3-9
Dan On Wed, May 20, 2009 at 1:46 PM, Richard Chudacoff <rchudacoff@mylinuxisp.com> wrote: If a patient presents breech in labor and she progresses rapidly and successfully, deliver her breech. However, condoning breech inductions is like condoning VBAC inductions; it may work, but more likely you will get sued without a sufficient defense for any little complication
Richard Chudacoff, MD, FACOG
-----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Charlie Chambers Sent: Wednesday, May 20, 2009 7:42 AM To: Multiple recipients of list OB-GYN-L Subject: Re: induction of breech at term
Perhaps I wasn't clear. We are working on a protocol to address vaginal breech deliveries. We have had much debate whether to mandate whether medically indicated inductions would be allowed in this protocol. I wanted to get the group's input with this issue. I understand that some of you believe that doing vaginal breech deliveries are currently a "crapshoot" medicolegally. Let's  just assume that tenet. However, I've had a very long look at the data and current national guidelines which do not view this as absolutely foolhardy. I also understand that lawyers will find any opportunity to exploit the system but that applies to entire field of obstetrics as well. I plan to go forward doing whatever I believe is the best medical care guided by evidence and not be wholly led by attorneys or by fear. Realizing that when the opportunity arises any of us by circumstance could be forced out of our chosen profession by the legal profession.
So, going back to my original question, those of you that still perform vaginal breech deliveries, what are your opinions about allowing medically indicated inductions?
Thanks. ************************************************************************** =0ACharlie Chambers
Hood River, OR USA cchamber@alumni. rice. edu
"I'm a goin fishin. Yeah, I'm goin fishin And my baby's goin fishin too!" Â Â Â Â Â Â Â Â Â Â Â Taj Mahal
************************************************************************ =0A =0AOn May 20, 2009, at 6:35 AM, Richard Chudacoff, MD wrote:
> That is different than have an induction protocol for breech
> deliveries
>
> Richard Chudacoff, MD, FACOG
> Las Vegas International Center for Advanced Gynecologic Care
> (Specializing in Minimally and Non-Invasive Surgery)
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Charlie
> Chambers
> Sent: Wednesday, May 20, 2009 5:56 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: induction of breech at term
>
> Thanks everyone for your input. The hospital is approaching this issue
> from the ACOG guideline which states that patients should have a
> version or offer for cesarean section. However, it is reasonable to
> offer a trial of labor under the guidance of "hospital specific
> protocol". The hospital is driving the desire to have such a protocol.
> I'm trying to guide the committee into coming up with a sound
> document. In addition, a consent is being generated which is pretty
> intimidating. I find this approach no different than some of the
> consents for VBAC that I've seen passed around. I do believe the net
> effect will be to convince all patients to have a cesarean section.
>
> **************************************************************************
> Hood River, OR USA
> cchamber@alumni. rice. edu
>
> "I'm a goin fishin.
> Yeah, I'm goin fishin
> And my baby's goin fishin too!"
> Â Â Â Â Â Â Â Â Â Â Â Taj Mahal
>
> ************************************************************************
> On May 19, 2009, at 2:20 PM, Richard Chudacoff wrote:
>
>> Charlie
>>
>> It seems like nobody on this list wants to give you any support for
>> your
>> breech protocol. Â On the other hand, as good friends, we are telling
>> you
>> that you probably should not support a breech protocol. Â Personally
>> I think
>> just supporting a protocol such as this jeopardizes your medical
>> career. Â So
>> you may want to think this thing over. As Art says, just my opinion;
>> it
>> could be wrong
>>
>> Richard Chudacoff, MD, FACOG
>>
>> -----Original Message-----
>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art
>> fougner, md
>> Sent: Tuesday, May 19, 2009 1:59 PM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: Re: induction of breech at term
>>
>> Whoever writes such a protocol may find himself in an institution.
>>
>> Just my opinion. I could be wrong.
>>
>> Art
>>
>> At Tue, 19 May 2009, Charlie Chambers wrote:
>>>
>> . I've
>>> looked over a number of other institutions who have protocols as
>>> well.
>>>
> *************************************************************************** =0A>> *
>>
>> --
>> art fougner, md
>> "May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>
>
-- R. Daniel Braun, MD Â FACOG(L) Â ABMP Â CMTh Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine
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