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Re: IUPC and VBACFrom: ATFSOCCER@aol.comFri Oct 3 20:31:47 1997
In a message dated 97-10-03 16:38:51 EDT, you write: << There are two issues here: 1) How do you ensure that an unsafe IUP is not happening during VBAc. I feel that this is not a problem, as dealth with by previosu mails in this thread. 2) How do you ensure that we don't cop out and do a repeat CS despite their being insufficient attempts to overcome "dystocia" by pumping up the IUP sufficently. Of course this assumes that IUP is the only valid measure and that the cervix is a total inert organ in the labour process. But in a setting whereby upto 85% successful VBAC results from NO IUPC, I wonder about how you can improve on that ! Malcolm Griffiths MD,MRCOG,MFFP,Cert.M >> In response to #2 I would say that every time you section someone for "non progression of her labor" (whether a VBAC or not) I would question you as to what was the quality and frequency of her contractions. The external toco would provide an estimate of the frequency but I would not rely on it for quantitating the strength of the contractions. If you can not document her contractions being over 250 Montivedeo units how do you know she has had an adequate trial of labor?!? Andy Folley MD FACOG
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