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Re: Trial of Labor? From: art fougner, md (evsono@pipeline.com) Wed Mar 31 11:10:54 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey H. Klein, MD: "Re: gynecologic oncologists" Previous message: art fougner, md: "Re: gynecologic oncologists" In reply to: Yvonne Fried, M.D.: "Trial of Labor?" Next in thread: Robert J. Woolley: "Re: Trial of Labor?" well, you could offer the option of TOL. But after ya get thru with the discussion of risk, together with her previous experiences, don't be terribly shocked when the couple request elective repeat c-section. Art "of course, that's just my opinion. i could be wrong." Dennis Miller At Wed, 31 Mar 1999, Yvonne Fried, M.D. wrote: > >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 > -- art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: Geffrey H. Klein, MD: "Re: gynecologic oncologists" Previous message: art fougner, md: "Re: gynecologic oncologists" In reply to: Yvonne Fried, M.D.: "Trial of Labor?" Next in thread: Robert J. Woolley: "Re: Trial of Labor?"

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