|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: Midnight Breech and Joseph FletcherFrom: Ari Gold (arig@getnet.com)Sat Feb 21 08:22:06 1998
At 11:41 PM 2/20/98 -0600, you wrote: >This is a stringy one: 26yo g2p1 (NSD uneventful 7-4) presents to L&D >tonight in active labor as fr breech, 2/50%, SRA just in pelvic inlet. >My partner failed ECV last week, but counselled RE vag breech and pt >agrees to await onset of labor and eval circumstances then. Covering >doc tonight is not in our office but is a good OB who just doesn't like >ANY breech and tells the patient why. She wants a tubal anyway, so they >agree to go for C/S,BPS....Now I get called to do the C/S cuz she's a pt >from our office and that's how the revenue flows. But I like breeches >so if I were "on" tonight this likely would be a vag del tonight and a >tubal tomorrow. If I do the planned C/S, I'll be home in an hour; if I >speak up for vag del, I'll be there all night with my partner's pt(he's >out of town) because I could not put the covering doc in potential >litigation's way. I have big family plans early tomorrow am. Real >world, real answers please. > >-- >Calvin J. Siegers, MD FACOG...private practice, 20 yr veteran, Holland, MI I'm impressed that you are even thinking about it, given that the patient has already agreed to a c-sec. I think at this point you need talk with the patient and get a full informed consent to do the breech (as of course you would anyway), but I see your exposure as higher in this case since the patient isn't pushing for a breech delivery, and standard of care isn't necessarily to deliver breeches vaginally. So, if she still wants the c-sec, you can go home and sleep soundly knowing you gave her the option, and that part of your job is to present the reasonable options and let the patient have a say in the care plan. If she decides to try the vaginal breech, then you'll be up all night, make less money, maybe miss your family plans tommorrow, or at least be exhausted for them, and still take the risk that she may not progress normally, or that there would be an adverse oucome. Tough choice. I think it would be valiant to go for the vaginal birth. Ingrid Gold, CNM arig@getnet.com
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:27:05 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.