Re: C-Section vs. Induction In Suspected Head/Pelvis Disproportion Cases

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Instead, he will send me for an >ultrasound at 38 weeks and consider the size of the baby and whether I
>should simply be scheduled for a c-section.
>
>What is the current OB wisdom on induction vs. c-section in possible
>disproportion cases?

This is one of the most difficult issues in obstetrics. On the one hand, there is no evidence that inducing "big" babies prevents any problems, and there is plenty of evidence that it may actually cause problems. I know this runs against intuition, and there is certainly no shortage of pregnant women who believe their baby is "too big." Again, however, from a statistical and scientific viewpoint, this does not stand up, and the numbers show that most women will do just fine with 8, 9, and even 10 pound babies.

However.... your potential problem is a little different, as there may be a contracted pelvis. Clinical pelvimetry is a difficult art, which involves measuring, using one's fingers, the dimensions of the bony pelvis. Some advocate MRI or CT scan for breech babies, but I don't know of many cases where this is done for someone trying to deliver a head-first baby. Most of us suggest giving labor a try, as almost all women with smaller than average pelvises seem to do well in labor. We would know more, though, if we could accurately and easily measure everyone's pelvis, then calculate how their labor progressed. In your case, it's a decision based on your ob's experience and physical examination. I don't base much on late ultrasounds, as they are notorious for "overcalling" the weight as more than it really is. They are really not a great test for determining how much the baby weighs (in fact, a medical study determined that the mom's guess was more accurate than either the ob's guess or the ultrasound)!

So, please talk this over with your doctor. If you have a funky pelvis and your last baby came out OP (occiput posterior, or "sunny side up" with the nose up), then your doctor is likely on to something and may have a good idea offering you a c/section. Best of luck.

--
Ashley Hill
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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