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En: C/S--I'm not surprisedFrom: Ricardo Savaris (savaris@orion.ufrgs.br)Sat Nov 29 07:21:51 1997
---------- > De: DMECNM@aol.com > Para: savaris@orion.ufrgs.br > Assunto: C/S--I'm not surprised > Data: Sexta-feira, 28 de Novembro de 1997 17:39 > > <<She is 1,61 m high and uterine height > WAS 41 cm. >> > > So what. Are you saying that someone of 1.61m cannot deliver vaginally? > Have you never had pt's less that 1.5m give birth to infants greater than > 4kg? Height is no justification for intervention. And more importantly, FH > is not an accurate measurement of fetal size. > > <<I started to induce her at 10:30 am. Inicial Bishop 2. Monitorization prior > induction was fine. I started with 50 mcg of misoprostol every 3 hours. > After 6 hours her Bishop went to 6. I started with oxitocin 20 mUI/min, > increased 20 mUI every 20 minutes until reach 100 mUI/min and no uterine > response. I indicated c-section at 9 pm. Was good enough?>> > > No, it wasn't good enough. What was her cervical dilation at 9pm? > What positon was the baby in? > What were the fetal heart tones? > Signs of fetal distress? > Why not turn off the pitocin and let her rest for the night? Restart again > in the morning. > You never gave valid reasons for induction, in the first place. Now you are > sectioning her for even less medical indication. > > <<Then my night mare started.>> > > Unfortunately for your patient, her nightmare started when she set foot in > your office. > > I never had such trouble to take the baby out. > The head did not come out, I sectioned one of the rectus abdominalis, and > nothing, then the baby turned and became transverse. We tried to extract > her in breech position. I grabed the good foot (in this case the good foot > was the one I could get), meanwhile the pediatrician was mad about me. We > started to take out the baby and again her head stucked. Tried the Brach > manuveur many times and nothing. My collegue started to turn around the > body and tried to pull out in OS, half the head came out and again stucked. > After a while she came out. APGAR 2/7. > > <<I lost 10 years of my youth in 3 min.>> > > I can only hope that you learned from your mistakes. But I don't think that > you did. Just read your next sentence. Your already getting suited up for > "next time." > > <<Any suggestion for next time, what about forceps? > > Ricardo Savaris, MD, MSc, TEGO > Porto Alegre, Brazil > savaris@orion.ufrgs.br > 55 51 3301354>> > > ----------------------- Headers -------------------------------- > Return-Path: <ob-gyn-l@obgyn.net> > ----------------------- Headers -------------------------------- > Received: from relay08.mail.aol.com (relay08.mail.aol.com > ----------------------- Headers -------------------------------- [172.31.109.8]) by > air11.mail.aol.com (v36.0) with SMTP; Thu, 27 Nov 1997 06:40:17 -0500 > Received: from talk.obgyn.net (talk.obgyn.net [208.2.98.99]) > by relay08.mail.aol.com (8.8.5/8.8.5/AOL-4.0.0) > with ESMTP id GAA05630; > Thu, 27 Nov 1997 06:40:03 -0500 (EST) > Received: from talk (server@localhost [127.0.0.1]) by talk.obgyn.net > (8.8.7/8.6.12) with SMTP id FAA19448; Thu, 27 Nov 1997 05:40:03 -0600 > Date: Thu, 27 Nov 1997 05:40:03 -0600 > Message-Id: <199711271137.JAA17528@orion.ufrgs.br> >
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