Cord 2x - automatic c-section?

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At Sat, 10 Apr 1999, Suzanne wrote: >
>I'd like to get the opinion of some of the docs here on a situation like this:
>
>Mom is 40 weeks, baby not in pelvis at all. U/S reveals that cord is
>wrapped around the baby's neck 2x, so dr decides on immediate c-section.

Suzanne-

I don't know of any studies that validate doing a c/section for a nuchal cord (or a double nuchal cord). As you know, about 15% of all pregnancies have a nuchal cord, and, despite popular belief, this almost never "cuts off" oxygen to the baby. However, it can cause variable decelerations, leading to assisted delivery with vacuum or forceps, or even a c/section during labor.

I suspect the dilemma is that even though (probably) only 1 out of hundreds of babies with nuchal cords will have any effects from this if the doctor you work with happened to have that one "bad baby," it would likely result in a huge lawsuit. Imagine the lawyer telling the jury that "all the doctor had to do was a c/section and this never would have happened." He might as well write a blank check to the parents, turn over his kid's college fund to them, and leave town. Unfortunately, the jury would never hear of the harm that would occur by doing a c/section for every single baby with a nuchal cord. Lots of sick moms, and likely a number of maternal deaths.

It's a tough call. I'll bet you would get an even split if you ask this question at the next large Ob/Gyn conference. If the mom wants a try at a vaginal delivery, after hearing the risks/benefits, I would probably go for it. If she declined, I would have no problem doing an elective c/section.

Best wishes,

Ashley

--
David Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, FL
http://home.mpinet.net/dahmd

The above is intended for general medical education,
and is not for specific medical advice.
I apologize, but I am unable to answer personal e-mail
due to time constraints.

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