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Re: "So, what brings you to Houston?"From: Jonathan May (jhmay@mailhost.tcs.tulane.edu)Wed Apr 3 08:06:34 1996
At 09:29 PM 4/2/96 -0600, you wrote: >Interesting case from today.. > >25 y/o G3P2 at 20 weeks gestation presented for her first prenatal visit >at our clinic (previously seen in Peurto Rico for prenatal care...) > >Prior obstetrical history is significant for first delivery by cesarean section >in Puerto Rico because the baby was "too big" (weight 8 pounds). Second >baby VBAC in Puerto Rico, 10 pounds.. >"Shows that first doc, I think to myself...." > >The rest of the history was unremarkable and I think she will be a good >candidate for a VBAC again. > >Just before leaving the patient, I was just being sociable and asked.. >"What brings you to Houston?" > >"I am here for the baby's surgery", she replies. >"what surgery?", I ask.. >"The one to fix the nerves in her arm..", she innocently offers. > >Apparently, the second child got a horrible shoulder dystocia and the >Erb's palsy persisted after one year requiring brachial plexus surgery.. > I consider a previous Erb's palsy one of the strongest contraindications to VBAC. I will always offer elective primary C-section to a patient with a history of severe shoulder dystocia. Although my feelings on this subject are probably affected by the time I've spent in court for shoulder dystocia, this is the same care I would want for my own wife.
-- Jonathan May
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