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Re: "Big Brother" in L and DFrom: Larry Glazerman (glazerman@enter.net)Mon Jan 6 15:07:19 1997
>It's been a long and crappy weekend, made better by a quick 20 mile bikeride >on a 65 degree Sunday afternoon, between coming home and now going back to >the hospital. > >39 YO P 0230 > >3 terminations, first trimester, long ago > >in 1995, first pregnancy, had in hospital IUFD at 26 weeks, terminated by >intraamniotic hemabate and delivery vaginally. She was in the house for >preeclcampsia deemed severe by evidence of IUGR. Perinatal consult, daily >NSTs, etc. > >This pregnancy, presented at 20 4/7 weeks with bulging membranes, and >underwent a rescue cerclage (pushed the membranes back with a 30 cc foley), >perinatal consult, etc. Presented 2 day ago contracting and bleeding, >apparently stopped on Mag and Indocin. Last night ruptured membranes, so I >pulled the cerclage, and gave her one 20 mg. PGE 2 supp, and she delivered a >447 g nonviable fetus and had a curettage after the placenta came out to get >it all. > >I guess this is someone with a poor obstetric history! > >Anyway, this intelligent upper middle class woman and husband were literally >blown away with our discussions about what to do with the baby (fetus) once >born. As everyone knows, a 21 5/7 weeker is previable (dates rock solid), >but many come out with movement, breathing, heartbeat, etc. > >In the old days, I would talk to these folks, and the fetus would stay in L >and D as long as the parents wanted, alive or not, and no ruckus is made. >However, a good guy attorney has advised me personally (the attorney >specializes in med staff matters) that this could be contrued as hasting a >death, so that the result won't be a severly handicapped baby. As we know, >a dead baby is "cheaper" than a damaged one. Thus, the attorney urges me to >always involve the neonatologist. Furthermore, I seem to have recollection >of a 1-800-federal goverment hot line to report mistreatment of infants, >babies, etc., in cases such as anencephalics who don't get treated with the >full court press. > >This kind of stuff interferes with my patient doctor relationship, which I >cherish and enjoy--that's what makes being up 3 nights in a row tolerable, >even at managed care wages. > >What do ya'll think and do? > >Garry E. Siegel, M.D. > >PS--Another wordy post--please email me privately whenever you want me to >shut up! I agree, a tough situation. Our hospital makes a distinction between these clearly previable fetuses, and the borderline ones at 24-25 weeks. At this age we don't have to involve NICU, although we usually call them to notify them as a courtesy. We haven't been concerned about the 1-800-LAWYER types.
-- Larry R. Glazerman, M.D. FACOG Valley Ob-Gyn Associates Allentown PA
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