--
OB-GYN-L Digest 956
Topics covered in this issue include:
1) Focal nodular hyperplasia in pre
by Terrence.Jones@ncal.kaiperm.org
2) Help From Friends
by richardc@bcm.tmc.edu (Richard M. Chudacoff, MD)
3) Re: Fibroids
by Kelly Shanahan <mks@sierra.net>
4) Re: FW: (fwd) one day in peace
by FlynnCNM@aol.com
5) Re: OB-GYN-L digest 954
by Sita Bhateja Nursing Home <sbnh@giasbg01.vsnl.net.in>
6) Re: Ectopic pregnancy- when to quit?
by "Joseph E. Shaeffer" <JSCNM@concentric.net>
7) Re: Advice re: Men in OB/GYN
by "Joseph E. Shaeffer" <JSCNM@concentric.net>
8) Vancouver ?
by DR A N MALPANI <malpani@giasbm01.vsnl.net.in>
9) Re: B6 and neurological damage.??? toxicity legit?
by jhellrie@pce.net (J. Hellriegel)
10) subscribe
by ZOLTAN_TAKACS@HP-Germany-om26.om.hp.com
11) Re: Acute pancreatitis, 40 wks, and more..
by nalbf@ime.net
12) Re: 25 YEAR OLD LIPPES LOOP
by rbraun@indyunix.iupui.edu
13) Re: 25 YEAR OLD LIPPES LOOP
by rbraun@indyunix.iupui.edu
14) b-HCG >1500
by "RICARDO FRANCALACCI SAVARIS" <savaris@orion.ufrgs.br>
15) Re: Advice re: Men in OB/GYN
by rbraun@indyunix.iupui.edu
16) Condylomas-Legal Opinion
by DMECNM@aol.com
17) Re: Advice re: Men in OB/GYN
by DoctorJoe@aol.com
18) Re: Fibroids
by DoctorJoe@aol.com
19) Re: Rubella Susceptible
by DoctorJoe@aol.com
20) Re: Recto-vaginal fistula in labour
by DoctorJoe@aol.com
21) Re: Fibroids
by Mats Bergstrom <matsb@cor.sos.sll.se>
22) Re: Advice re: Men in OB/GYN
by douglas.krell@nsionline.com (douglas krell)
23) Re: new method for cervical ripening
by Richard Lowensohn <lowensoh@ohsu.edu>
24) Re: Advice re: Men in OB/GYN
by Lisa Maria Soule <lsoule@umabnet.ab.umd.edu>
25) Re: Advice re: Men in OB/GYN
by DoctorJoe@aol.com
26) Urodynamics (CMG)
by cro@lex.infi.net (Jack Crone)
27) Re: 25 YEAR OLD LIPPES LOOP
by DrBarrere@aol.com
28) Re: Rubella Susceptible
by Malcolm Griffiths <malcolm@mgriff22.demon.co.uk>
----------------------------------------------------------------------
Date: Wed, 9 Apr 97 17:40 PDT
----------------------------------------------------------------------
From: Terrence.Jones@ncal.kaiperm.org
----------------------------------------------------------------------
To: ob-gyn-l@obgyn.net
Subject: Focal nodular hyperplasia in pre
Message-ID: <m0wF7uL-0001seC@taogws2>
Please don't flame me for forwarding, it takes more Betz cells than I can
spare right now to edit and send...
Ken, would wonder Re: diagnosis in this case - HA (hepatic adenoma) VS
FNH (focal nodular hyperplasia). You might try Dr. Nagorney at Mayo - the
review on their experience is published in World J Surg Jan-Feb/95, vol 19:
13-8. A tissue Dx of FNH demonstrates little assoc with estrogen, either in
occurence with use (ie BCP's) or resolution with cessation of use. Other
recent reports tend to support this as well. For instance, a study by Shortell
(Surg Gynecol Obstet 11/91, vol 173:426-31) describes a 50-60% rupture and
IPH (intra-peritoneal hemorrhage) rate with HA (hepatic adenoma), tho FNH is
rarely assoc with any complications. Tho the diagnostic imaging literature
seems replete with comparitive sensitivity/specificity testing with duplex-
pulse-gadolinium enhanced-filling/emptying phase-CT-doppler sono-digitally
subtracted MRI; there seems to be NO reliable substitue for a tissue Dx. The
Shortell study also points out HA's are the benign neoplasm most often assoc
with enlargement in a dose-duration-dependent manner with oral contraceptives.
They will be larger than in pts not on BCP's, and demonstrate higher rates of
bleeding and rupture. FWIW, tho both HA's and FNH have a malignant potential
(the latter advancing to 'fibrolamellar' HCC (hepatocellular carcinoma), it
is only the former in which this occurs with any numerical significance. In
assessing this risk, as mentioned last Jan (1996) in ref to Geff's Pt. with
"Really High MSAFP", there IS a biochemical marker for this transformation.
Might wanna' glance at the Becker paper (Am Surg 3/95, vol 61:210-14) ---
{note: this is Am Surg *not* Am "J" Surg} --- which also supports the
greater neoplastic and rupture rate of HA's. However, their report focuses
on the rare case of an 18 yo with sudden onset RUQP and hemoperitoneum. The
path reveals FNH!!!! She was never pregnant nor did she ever take BCP's. In
their subseq. review they were able to come up with only two other reports
in the english literature. So IF your Pt has FNH (NOT HA), it would seem she's
just as unlikely to rupture when pregnant as when not. The prior studies
evaluating estrogen receptors on benign hepatic neoplasms were biochemical
in methodology. A study by Masood (Arch Path Lab Med 12/92, vol 116:1355-9)
showed NO sig Estrogen, nor Androgen receptors in these (benign) neoplasms
when monoclonal AB testing was performed. (However, their N, so don't
rush to any conclusions). Talk to your Hepatologist -- my guess is that
these lesions 'start out' vascular (sinusoidal ectasia/telangiectasia), and
then evolve with hepatocyte necrosis and intrasinusoidal fibrosis. So, if
it's going to bleed it's probably more likely to during its early development.
Has this lesion been around for some time?
Good news on the Hydralazine issue -- it seems "SoloPak" pharm is now
"ready for delivery". For further info: 1-800-276-5672, or 708-806-0080.
Regarding Kartagener as a cause for recurrent ectopic - that's a bit of a
stretch even for me! Would think this unlikely in the absence of the triad
(Dextrocardia/situs inversus, bronchiectasis, chronic sinusitis). It does
raise the issue of non-auto-recessive transmission, as one family is sugg.
of X-linked. In which case, watch for RDS secondary to primary ciliary
dyskinesia in the newborn.
Back to Dr. Moise -- what'd you decide with your Pt. on Valproate? tj.
--------------------------( Enclosure 1 follows )----------------------------
--------------------------( Enclosure 1 follows )--------------------------Date: Monday, 7 April 1997 8:29pm
--------------------------( Enclosure 1 follows )--------------------------
From: "Kenneth J. Moise" <kmoise@bcm.tmc.edu>
Subject: Focal nodular hyperplasia in pregnancy
Sender: ob-gyn-l@obgyn.net
To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
Errors-to: ob-gyn-l-request@obgyn.net
Precedence: bulk
Originator: ob-gyn-l
X-Comment: list for discussion of obstetrics and gynecology
X-Listprocessor-version: 6.0c -- ListProcessor by Anastasios Kotsikonas
Reply-To: kmoise@bcm.tmc.edu
One last try.
Does anyone have any experience with a case of hepatic focal nodular
hyperplasia in pregnancy?
I have a patient at 6 weeks' gestation who is considering termination in
view of the literature that states that hepatic adenoma can enlargen
under the influence of the estrogens in OCP's.
Ken Moise
Baylor College of Medicine
------------------------------
Date: Wed, 9 Apr 1997 20:01:50 -0500 (CDT)
------------------------------
From: richardc@bcm.tmc.edu (Richard M. Chudacoff, MD)
--
------------------------------
To: OB-GYN-L@OBGYN.net
Subject: Help From Friends
Message-ID: <199704100101.UAA24854@talk.obgyn.net>
My neighbor's child, 5 year old Kelly Miller, is at Children's Hospital
in Houston, end stage with Aplastic Anemia. There is a desparate need
for O (+) and O (-) granulocytes to help her fight a disseminated fungal
infection. If you are in the area, and you or someone you know match
this blood type, and have the time, please call and donate.
Thanks for your understanding of my using the list for this purpose.
Rick
--
Richard Chudacoff, MD
Baylor College of Medicine
BaylorMedCare
Houston/Richmond, TX
------------------------------
Date: Wed, 9 Apr 1997 18:22:22 -0700
------------------------------
From: Kelly Shanahan <mks@sierra.net>
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: Fibroids
Message-ID: <199704100122.AA11690@genoa.tol.net>
At 03:46 PM 4/9/97 -0500, you wrote:
..snipped..... She has about a 12 wk size uterus, with
>most of the fibroids on the exterior.
>
>She has heard somewhere about a treatment involving ligation of the blood
>supply to the fibroids, resulting in their shrinking. She has a lot of
>discomfort from the fibroids, in addition to the infertility.
>
>Does anyone know of a reference to the ligation as above? Any ideas? She
>is willing to be referred to almost anywhere to get this done.
>
>Jude Kurokawa, CNM
>Wolf Point, MT (The Last Best Place)
>mailto:jkuro@midrivers.com
>
Jude
The radiologists are basically doing angoigrams and embolizing the vessels
supplying the fibriods. I can't remember where I read the original articles,
but there have been comments and articles in the "throwaways" like ObGyn
News and Contemporary OBGYN. Sorry my memory isn't better. Maybe MEDLINE
would be the next step.
Kelly Kelly Shanahan, MD
S. Lake Tahoe, CA
------------------------------
Date: Wed, 9 Apr 1997 21:47:52 -0400 (EDT)
------------------------------
From: FlynnCNM@aol.com
------------------------------
To: ob-gyn-l@obgyn.net, ob-gyn-l@talk.obgyn.net
Subject: Re: FW: (fwd) one day in peace
Message-ID: <970409214549_607920485@emout05.mail.aol.com>
> This is a 24-hour concept where no guns are fired
> anywhere on earth ... including on television.
Any chance we could include the print media as well? Would there be any
"news" left in the newspapers/magazines?
Cynthia B. Flynn, CNM, PhD
Private Practice
Kennewick, WA 99336
------------------------------
Date: Thu, 10 Apr 1997 07:35:50 +0500 (GMT+0500)
------------------------------
From: Sita Bhateja Nursing Home <sbnh@giasbg01.vsnl.net.in>
------------------------------
To: ob-gyn-l@obgyn.net
Cc: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
Subject: Re: OB-GYN-L digest 954
Message-ID: <Pine.OSF.3.96.970410073114.29587A-100000@giasbg01.vsnl.net.in>
i have used cytotec .i am not happy. it is a very potent drug .using
vaginally it causes contractions and painlessly the uterine tone is
increased. it causes foetal hypoxiawithout being observed. i would say you
can easily do without it..sbnh .sita.
------------------------------
Date: Wed, 09 Apr 1997 20:38:16 -0700
------------------------------
From: "Joseph E. Shaeffer" <JSCNM@concentric.net>
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: Ectopic pregnancy- when to quit?
Message-ID: <334C60A8.4314@concentric.net>
Travis D. Klingler wrote:
> > Joseph E. Shaeffer wrote:
> >
> > Dan Logen wrote:
> > >
> > > ----------
> > > > From: MajMahan@aol.com
> > > > To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
> > > > Subject: Ectopic pregnancy- when to quit?
> > > > Date: Sunday, April 06, 1997 12:49 PM
> > > >
> > > > A 23 yo g5p1031 (2ectopics, 1miscarriage, 1term delivery)
> > > .
> > >
> > > I must admit that I can never figure out what all the numbers after the "p"
> > > mean. I understand that she has been pregnant 5 times and has had one
> > > delivery, but how about the "031" ? TIA to someone.
> > >
> > > Dan Logen
> > > Private Practice OB-GYN
> > > Mt. Vernon, WA
> > Dan,
> > An easy way to remember is TPAL,
> > Term Pregnancies Pre Term Abortions Living Children
> > T P A L
> > so the above G5 P1031 is T/1 P/0 A/3 L/1
> > Thats how I learned,
> > Joseph Shaeffer ARNP/CNM in Spokane, Eastern WA.
> > Might I also add a simple mnemonic that helps me remember the order in
> which the numbers are reported: Tennessee Power And Light
> T P A L
> That's how it's taught at Creighton University. I hope it helps.
> > Travis D. Klingler, M3
> Creighton University
> Omaha, NE
For a T substitute Dan could use Tacoma Power and Light
T P A L
those of us in the pacific northwest don't know about Tennessee!
thanks Travis,
Joseph Shaeffer
------------------------------
Date: Wed, 09 Apr 1997 20:37:48 -0700
------------------------------
From: "Joseph E. Shaeffer" <JSCNM@concentric.net>
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: Advice re: Men in OB/GYN
Message-ID: <334C603E.18D0@concentric.net>
Travis D. Klingler wrote:
> > I am a third year medical student at Creighton University at the close
> of my OB/GYN clerkship. Within the next few months, I must choose which
> What do you think? Any advice is sincerely appreciated.
> > Travis D. Klingler, M3
> Creighton University Medical School
> Omaha, NE
> (402)596-0923
Travis,
I'm a male NurseMidwife with twenty years experience in womens health
first as a labor and delivery nurse, people said I could never do that,
a women's health care nurse practitioner, people said that would never
fly, and five years as a cnm, lots of people said no way, I followed my
heart, have always felt what people have been telling you, that it's not
gender it's who you are as a physician, who you are as a person, do you
care about the person sitting across from you in the exam room, do you
have respect for that individual as a person, if so they will respect
you and you will do fine.
just my .02
Joseph Shaeffer ARNP/CNM
------------------------------
Date: Thu, 10 Apr 1997 09:36:43 +0530 (GMT+5:30)
------------------------------
From: DR A N MALPANI <malpani@giasbm01.vsnl.net.in>
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Vancouver ?
Message-ID: <Pine.OSF.3.95.970410093458.13346E-100000@giasbm01.vsnl.net.in>
I will be attending the 10th World Congress
on IVF and Assisted Reproductive Technology
to be held in Vancouver from 24 - 28 May 1997,
with my wife.
Will anyone else on this list be there ?
NB> I will be staying at the Hotel Georgia.
Dr Malpani, MD
Founder and Medical Director, Health Education Library for People
India's First Consumer Health Education Resource Center
"Om Chambers", Kemps Corner, Bombay 400 036. India.
FAX: 91-22-215 0223 email: malpani@pobox.com
Please visit our homepage at http://www.allindia.com/helplib !
------------------------------
Date: Wed, 9 Apr 1997 23:35:55 -0500 (CDT)
------------------------------
From: jhellrie@pce.net (J. Hellriegel)
------------------------------
To: OB-GYN-L@OBGYN.net
Subject: Re: B6 and neurological damage.??? toxicity legit?
Message-ID: <199704100435.XAA28294@talk.obgyn.net>
At Tue, 08 Apr 1997, mark decker wrote:
>
>I had a patient tell me she red an article by a nutrition phd that warned
>of neuro toxicity with more than 200mg of B6 qday. I frequently have
>patients use 200-300 qday. some..a fair amount respond better to 300mg or
>so I think.
>
>anyone else heard this? comments..ideas?
>
>thanks.
>
>Mark D.
>mark decker md
--
You may find the following helpful.
--
Authors
Schaumburg H. Kaplan J. Windebank A. Vick N. Rasmus S. Pleasure D.
Brown MJ.
Title
Sensory neuropathy from pyridoxine abuse. A new megavitamin syndrome.
Source
New England Journal of Medicine. 309(8):445-8, 1983 Aug 25.
Abstract
We describe seven adults who had ataxia and severe
sensory-nervous-system
dysfunction after daily high-level pyridoxine (vitamin B6) consumption.
Four were severely disabled; all improved after withdrawal. Weakness
was
not a feature of this condition, and the central nervous system was
clinically spared. Although consumption of large doses of pyridoxine
has
gained wide public acceptance, this report indicates that it can cause
sensory neuropathy or neuronopathy syndromes and that safe guidelines
should be established for the use of this widely abused vitamin.
--
J. Hellriegel, Jr., MD, PhD
------------------------------
Date: Thu, 10 Apr 97 09:48:30 +0200
------------------------------
From: ZOLTAN_TAKACS@HP-Germany-om26.om.hp.com
------------------------------
To: ob-gyn-l@obgyn.net
Subject: subscribe
Message-ID: <H000068800702938@MHS>
subscribe
------------------------------
Date: Thu, 10 Apr 1997 06:52:50 -0400 (EDT)
------------------------------
From: nalbf@ime.net
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: Acute pancreatitis, 40 wks, and more..
Message-ID: <v01510100af723c4377eb@[208.198.240.38]>
>
>U/S RUQ noted multiple gallstones in the gallbladder. No signs of
>cholecystitis.
>
>What should I do next?
>
>Geffrey Klein MD gklein@bcm.tmc.edu
Geff<
Sounds like a typical case of gallstone pancreatitis. With a normal
bilirubin and no common duct dilitation it does not sound like she has a
common duct stone at this time. I would keep her npo, give her analgesics
and hydration and follow her lytes, amylase, bilirubin, vital signs and
clinical appearance as well as the baby's status. I'd also get your general
surgeon of choice involved early. She should improve over the next few
days. Once she's better, induce her, get her delivered. She'll need her
gallbladder out sooner or later. Hopefully when the uterus is small enough
to permit laparoscopic cholecystectomy.In the worst case scenario, if she
is showing signs of acute cholecystitis, you and the surgeon could always
do a combined c-section and open cholecystectomy.
Good luck.
Jay Naliboff, MD
Farmington, ME
------------------------------
Date: Thu, 10 Apr 1997 06:39:51 -0500 (EST)
------------------------------
From: rbraun@indyunix.iupui.edu
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: 25 YEAR OLD LIPPES LOOP
Message-ID: <Pine.HPP.3.95.970410063609.23891A-100000@champion.iupui.edu>
I certainly would not subject an asymptomatic 52 Y/O to a general
anesthetic just to remove a 25 Y/O Lippes Loop. It is inert plastic and if
it hasn't caused a problem in 25 years, why think that it will now. BTW an
old fashioned Novak curette frequently works very well for removing IUD's.
Oh yeah, Why the hysteroscopy??? Because it was there!!
--
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
R. Daniel Braun, MD FACOG "Money will buy you a fine dog
Clinical Professor OB/GYN but only love will make it
Indiana University School of Medicine wag its tail"
Indianapolis, IN Richard "Kinky" OBGYN.net, International Rep. U.S. Friedman
Kinky Friedman for President
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
On Tue, 8 Apr 1997 EboDoc@aol.com wrote:
> A new case for the list. 52 yr old with Lippes loop for 25 years. No
> problems.
> She is new patient and diag hysterscope shows lippes on posterior wall. > unable to remove in office. Did not have a Knitting type needle, but all
> long
> forceps were unsucessful in grasping due to jaws and hinge configuration.
> A 0 and #1 currette were also unsucessful. I need to know if there is any
> evidence
> that would suggest that this be removed in the OR. I intend to get a IUD
> type hoo
> remover and give that a try. The couple is concerned whether there is any > compelling reason to proceed any furthur- I am unaware of any data regarding
> chronic inflammation and neoplasia. > ebodoc
> Ed Ryan,M.D.
>
------------------------------
Date: Thu, 10 Apr 1997 06:43:26 -0500 (EST)
------------------------------
From: rbraun@indyunix.iupui.edu
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: 25 YEAR OLD LIPPES LOOP
Message-ID: <Pine.HPP.3.95.970410064229.23891B-100000@champion.iupui.edu>
WHY ???? I am referring to the hysteroscopy.
--
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
R. Daniel Braun, MD FACOG "Money will buy you a fine dog
Clinical Professor OB/GYN but only love will make it
Indiana University School of Medicine wag its tail"
Indianapolis, IN Richard "Kinky" OBGYN.net, International Rep. U.S. Friedman
Kinky Friedman for President
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
On Tue, 8 Apr 1997, Bernard Cristalli wrote:
> Try a Novack canula. Or an hysteroscopy in the OR. > > -- > Bernard Cristalli MD CNGOF
> Paris - France
> http://www.obgyn.net/corresp/cristalli.htm
>
------------------------------
Date: Thu, 3 Apr 1997 20:55:21 -0300
------------------------------
From: "RICARDO FRANCALACCI SAVARIS" <savaris@orion.ufrgs.br>
------------------------------
To: <ob-gyn-l@obgyn.net>
Cc: "OBGYN forum" <:ob-gyn-l@obgyn.net>
Subject: b-HCG >1500
Message-ID: <199704101154.IAA29538@orion.ufrgs.br>
Dr. Mark wrote:
I have two cases with hcG over 1500 and U/S showed no embryonic cardiac activity, complex adnexal mass and even one with some free fluid..... both turned out to be twin IUP's.... sorry to complicate matters
I was wondering why you had this situation. The levels of b-HCG and the
diagnosis are based on a paper from Ankum (H. Reproduction 1993 Vol. 8, p
1301-6). The possible answer for your case is that the two embrios are
capable enough to produce high levels of HCG, but they are too small to be
seen by U/S, or your U/S was not well performed; unless you have a highly
sensitive doppler, I should looking for a gestacional sac and not cardiac
activity. But although this particular situation is the exception, I would
do a laparoscopy anyway.
Ricardo F. Savaris, M.D., MSc,
TEGO-FEBRASGO
Porto Alegre, Brazil
e.mail: savaris@orion.ufrgs.brl
Tel 55 51 3301354
------------------------------
Date: Thu, 10 Apr 1997 06:59:38 -0500 (EST)
------------------------------
From: rbraun@indyunix.iupui.edu
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: Advice re: Men in OB/GYN
Message-ID: <Pine.HPP.3.95.970410065443.23891D-100000@champion.iupui.edu>
I think the real issue here has been neglected. It is not gender. It is
form of practice. Over the next decade, I see more and more women going to
midwives for routine care (OB & GYN). and fewer and fewer going to
OBGYN's.This is in a field which is already overpopulated nationally. Yes
there are rural areas out there that need OBGYN's but they have a habit of
driving them off when they do get one. Producing more OBGYN's will not
help the rural areas. Producing more MD's didn't help them, it just
brought on HMO's. Sorry to be the wet blanket, but I think this is the true issue unvolved.
--
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
R. Daniel Braun, MD FACOG "Money will buy you a fine dog
Clinical Professor OB/GYN but only love will make it
Indiana University School of Medicine wag its tail"
Indianapolis, IN Richard "Kinky" OBGYN.net, International Rep. U.S. Friedman
Kinky Friedman for President
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
------------------------------
Date: Thu, 10 Apr 1997 08:44:12 -0400 (EDT)
------------------------------
From: DMECNM@aol.com
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Condylomas-Legal Opinion
Message-ID: <970410084410_973094674@emout04.mail.aol.com>
My husband did the search that Dean Huffman suggested. This is what he
found. It is really LONG (not surprised) so I took out the main information.
Citation/Title
859 F.Supp.22, Randall V. U.S., (D.D.C. 1994)
RANDALL v. UNITED STATES
Civ. A. No. 91-2919-OG
United States District Court
District of Columbia
Aug 2, 1994
"Patient brough medical malpractice action against military hospital.
The District Court, Gasch, Senior District Judge, held that : (1) patient
had not established that there was a national standard of care, as to whether
Caesarean section should be performed upon evidence that patient had genital
warts attrituble to human papilloma virus (HPV), precluding claim that
physicians had been negligent in not performing Caesarean section so as to
avoid infant's exposure to warts; (2) physicians had not obtained informed
consent of patient to vaginal delivery, as they had not warned her of the
dangers inherent in that delivery in presence of genital warts and given her
option of selecting vaginal or Caesarean delivery; and (3) damages could
include allowance for operations on infants required to remove respiratory
warts every two months, until child reaches age 14."
."In order to establish causality aspect of medical malpractice claim, it
is not necessary for expert to testify he was personally certain that patient
would not have sustained injury but for physician's negligence; it is
sufficient for expert to state opinion, based on reasonable degree of medical
certainty, that physician's negligence was more likely than anything else to
cause, or be a cause, of victim's injuries."
."Patient claiming that her infant daughter contracted juvenile laryngeal
papillomatosis (JPL) due to passage down birth canal which contained
undiagnosed genital warts did not establish there was national obstetrical
standard of care requiring Caesarean section delivery under those
circumstances, so as to avoid exposure to warts; some experts testified that
Caesarean delivery would be offered only if there were HPV lesions
obstructing birth canal, or when there existed risk of increased bleeding or
infection..."
."For purposes of determining whether patient had given informed consent to
undergo a vaginal delivery, as opposed to a Caesarean section, physicians had
duty to disclose to her, based upon pap smear and colposcopy examination
conducted approximately six and three months prior to delivery, that she had
genital warts arising from infection with HPV, and should have counseled her
regarding rish to respiratory system of child from passing through birth
canal versus risks attendant to Caesarean delivery.
."was entitled to damages in amount of $500,000."
Denise M. Ellison, CNM
------------------------------
Date: Thu, 10 Apr 1997 09:57:39 -0400 (EDT)
------------------------------
From: DoctorJoe@aol.com
------------------------------
To: ob-gyn-l@obgyn.net
Subject: Re: Advice re: Men in OB/GYN
Message-ID: <970410095735_-268129698@emout10.mail.aol.com>
<<Yes
there are rural areas out there that need OBGYN's but they have a habit of
driving them off when they do get one. Producing more OBGYN's will not
help the rural areas. Producing more MD's didn't help them, it just
brought on HMO's. >>
Well, as an Admissions Committee member, one thing I can attest to is the
increased AGE of medical school matriculants, as well as an increase in the
proportion of WOMEN. This leads to an interesting phenomenon... shorter
professional lifespan for the physicians.
Obviously, "older" docs don't practice as long. Also, women statistically
practice fewer years. So... we're decreasing our "physician density" (cool.From funaie@is4.nyu.edu Tue Apr 15 10:33:25 CDT 1997
>From nobody@obgyn.net Tue Apr 15 10:33:25 1997
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Date: Tue, 15 Apr 1997 10:33:25 -0500 (CDT)
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From: funaie@is4.nyu.edu (Edmund F. Funai, MD)
To: OB-GYN-L@OBGYN.net
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Subject: Re: Fetal fibronectin question
At Mon, 14 Apr 1997, dahmd@gate.net wrote:
>
>As tragic as it is, the "men in Ob/Gyn" thread is coming to an end :)
>
>So, here's a situation that recently left me grasping for advice. My
>partner performed an outpatient fetal fibronectin test (I don't
>routinely do them) on a patient at 30 weeks who was having irregular
>contractions, regular labor and delivery triage visits, but no evidence
>of cervical dilatation, infection, fetal distress, etc. Two days later
>while on call I received a phone call from the fibronectin lab reporting
>this as "positive". The patient had not returned and as far as I know
>had no complaints. Thanks in advance.
>
>Do I:
>
>1. Phone the patient to check up on her?
>2. Wait until she returns with contractions?
>3. Admit her for steroids and observation? (This was suggested by a
>company rep over lunch one day).
>4. Put her on home monitoring?
>5. Some other suggestion?
>
>Ashley
>D. Ashley Hill,M.D.
>dahmd@gate.net
>Orlando, FL
--
Since reported on by Charles Lockwood, Fetal Fibronectin has been the focus of many studies.
>From the available evidence, I can advice you on the data. The test has a reasonable sensitivity
but only about a 12.7% positive predictive value according to Matria's own litereature.
However, the specificity is about 80%, with a negative predictive value of greater than 95 %.
What this all means is that a positive test puts a patient at greater risk for preterm delivery, but does in way way predict it reliably.
A NEGATIVE test, though, reasonably assures you that the patient will not deliver within two weeks and probably doesn't require
aggressive in-hospital management.
There are many settings where fetal fibronectin may not be reliable at all. For example, prior to 24 weeks it is normally expressed.
It may also not be reliable in asymptomatic women or after digital exam ( fibronectin may be a trophoblast "glue" that binds the membranes to the deicidua and may be disrupted
by an exam or advanced dilatation).
I would closely observe a positive result. The patient has a several fold risk of preterm delivery, depending on which study you read.
The most helpful may be a negative one, because it may assure even in the face of some symptoms, that the patient WON'T deliver.
