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Re: Trial of Labor?From: Braun, R. Daniel (rbraun@iupui.edu)Wed Mar 31 07:37:29 1999
Why wait til term to do your clinical pelvimetry? Like you, I have done 3 C/S on the basis of clinical pelvimetry. One had Ollier's syndrome (Multiple enchondromas) her largest AP diameter was 3.5 cm. Another had been in a car accident and had a fractured pelvis that healed with much distortion of the anatomy. The third had a conjugate diagonal of 8 cm.. You might try to write to the Swiss and Norwegian physicians and ask them. Mats might even know one of them. Dan R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN -----Original Message----- From: hcw@mind.net [SMTP:hcw@mind.net] Sent: Wednesday, March 31, 1999 1:32 AM To: Multiple recipients of list OB-GYN-L Subject: Trial of Labor? I am taking care of a 37 yo G3/P2 now at 18 weeks gestation who had a primary cesarean section in her first pregnancy without a trial of labor based upon clinical pelvimetry. This was done in Switzerland. She then moved to Norway, had a second pregnancy and she had x-ray pelvimetry performed. She was counseled against a VBAC. So she had a repeat C/section. She is Irish, 5'2" tall, married to a North American who is about 6 feet tall. 1st baby weighed 8#, 2nd baby 7 1/2#. She denies ever having had a motor vehicle accident or fracturing her pelvis. She has no abnormalities of the spine (such as scoliosis). I didn't perform her intake visit in our office; I have yet to perform "clinical pelvimetry". Both C/sections were low transverse uterine incisions. Apart from one patient with a history of a motor vehicle accident with pelvic fracture and documented abnormality of the bony pelvis, and one patient with short stature 4'10" with a large baby, I have never outright done a primary c/section without a trial of labor. I have done a few successful VBACs in patients with 2 prior c/sections. Anybody want to hazard a guess at what the Swiss doctor was thinking? How about the Norwegian doctor? The patient and her husband want "what's best for the baby." My inclination is to perform clinical pelvimetry at term, offer a trial of labor if appropriate; if there is arrest of dilation or descent with good contractions then go to c/section. Any comments? -- Yvonne Fried, M.D., FACOG
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