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Prior cesarean From: James Taylor (taylorj@texas.net) Thu Jul 31 18:49:15 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: dahmd@gate.net: "Re: The chronically torsed ovary" Previous message: dahmd@gate.net: "Re: Prior cesarean, SGA, need your help.... (off the subject..)" Next in thread: Ronald R Helm: "Re: Prior cesarean" Maybe reply: Ronald R Helm: "Re: Prior cesarean" -- ---------- > From: Geffrey H. Klein, MD <gklein@bcm.tmc.edu> > To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net> > Subject: Re: Prior cesarean, SGA, need your help.... (off the subject..) > Date: Wednesday, July 30, 1997 10:42 PM > > I counsel with risks and benefits as follows: > > 1) Better to deliver vaginally. > 2) Risk of uterine rupture up to 1% (if known LUT) Do you inform your patients that pitocin augmentation/induction greatly increases the chance of uterine rupture, and that the risk is much lower if pitocin is not used? Do you inform your patients that 75% of uterine ruptures occur in women who have never had prior cesareans? > 3) consequences of uterine rupture potentially but not always devastating > (fetal harm/death, maternal hemorrhage, hysterectomy, blood transfusion, > etc) Do you inform your patients that most "ruptures" are merely dehiscences requiring no medical attention, and not complete ruptures? > 4) elective cesarean less morbid than repeat cesarean after failed TOL > 5) chance of successful VBAC 60-80% > 6) morbidity from elective cesarean greater than that of vaginal delivery. Do you review these risks? > 7) encourage trial of labor > > However, if patient says repeat cesarean, that is the END OF DISCUSSION. > Bottom line, it is her body. She has thought it through and it is a > reasonable request. She gets what she wants. Does this also apply to other requests as well, such as no IV, no episiotomy, intermittent rather than continuous fetal monitoring, etc? > If she elects for TOL and > then in labor requests cesarean, I do it. If a woman is not informed of all the statistics, she is not truly making an informed decision. Many women are simply afraid of the unknown and need encouragement. J. Taylor Next message: dahmd@gate.net: "Re: The chronically torsed ovary" Previous message: dahmd@gate.net: "Re: Prior cesarean, SGA, need your help.... (off the subject..)" Next in thread: Ronald R Helm: "Re: Prior cesarean" Maybe reply: Ronald R Helm: "Re: Prior cesarean"

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