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Re: 38 weeks, 2 previous myomectomiesFrom: Marco A. Pelosi, III, MD (marcop@tao.agoron.com)Tue Dec 23 07:56:38 1997
At Mon, 22 Dec 1997, Garry E. Siegel, M.D. wrote: > >When in doubt, cut it out. I would suggest that you have a conversation >with this patient, and tell her that labor without her op note is >unknown territory; you just don't know. > >Thus, the safest thing is a section, realizing that an "unnecessary >section" is a morbid procedure when compared to a vaginal delivery. > I agree. There is absolutely no reason to play Russian Roulette with this woman's uterus for the misperceived "magic" of vaginal delivery. Excluding the local butcher, the morbidity of elective cesarean section is practically nil and limited mostly to mild fevers. Would you trade a week's worth of ampicillin (cost: <$5.00/ probability < 5%) for a chance to blow out her uterus (cost: >$5.00/ probability unknown)? Second point: I would disagree that vaginal delivery is less morbid than cesarean delivery for women who suffer significant pelvic floor damage and dysfunction as a result of the former. Unfortunately, it's not possible to reliably identify these women before the damage occurs.
-- M.A. Pelosi, III, MD
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