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EpisiotomyFrom: rbraun@indyunix.iupui.eduMon Jun 30 18:42:18 1997
I have just returned to my office from L & D where I just shortened a woman's second stage by doing an episiotomy. P 0 G 1 has been in the second stage for 95 minutes. For the last 10 minutes, the head is at +6 station and separating the labia 6 cm. with each contraction and greatly distending the perineum. For the last 8 minutes, the heart rate has not been above 60 BPM. In my extensive clinical experience from watching hundreds of others just like this without the prolonged endstage deceleration, it will take another 4-5 contractions for this patient to push this head on out. That is at least another 8-10 minutes of 50-60 BPM. I did a midline episiotomy and she delivered with the next contraction. That is a clinically significant shortening of the second stage. The only way to do an RCT on this situation is to take a number of patients (would have to do a power study to find out how many needed) at this stage of labor (labia separated 6 cm. for the last 10 min.) and at that point randomize them (to cut or not to cut), then see how many in each group take how long. None of the studies that I ma aware of did this. I also want to know who drew the envelope for the randomization if there are any.
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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
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