PREGNANCY-BIRTH Messages for May, 1999: Re: labor induction at 41.5 wks vs expectant management

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Re: labor induction at 41.5 wks vs expectant management

From: anonymous@obgyn.net://www.HOTMAIL.COM
Thu, 20 May 1999 04:38:28 -0500 (CDT)

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At Sun, 28 Feb 1999, Kelly Shanahan, MD wrote: >
>At Sun, 28 Feb 1999, bj wrote:
>>
>>Hello, thankyou in advance for your time.
>>My wife is at 41.5 wks pregnancy. She is scheduled for induction in a
>>few days. The baby was evaluated by u.s. 3 days ago and is fine, and
>>my wife's cervix is 'unfavorable' at this time. This is our second
>>child, our first was delivered by scheduled C section due to breech
>>presentation, transverse incision. We're having second thoughts about
>>the induction, we feel that maybe given a little more time things could
>>progress naturally on their own. We are trying to educate ourselves
>>about the options, our doctor is much too busy it seems to discuss with
>>us what these options might be.
>
>No doctor should ever be too busy to discuss options and the risks and
>benefits of those options.
>
> From our reading, we are thinking
>>perhaps waiting an additional week might be possible, with twice weekly
>>checkups and daily at-home prostoglandin gel application on or near her
>>cervix
>
>Twicwe weekly checkup, with once or twice weekly NSTs (non-stress tests)
>and weekly fluid check by ultrasound would be reasonalble. Daily fetal
>movement counts should also be done and any change in hte baby's usual
>pattern ahould be immediately reported to your doctor.
>
>As for the home prostaglandin gel, it not done, at least where I
>practice. Prostaglandins are wonderful at ripening the cervix, but
>should be applied in the hospital -- or at least in the office and hen
>baby is monitored for a while afterwards.In your wife's case, with the
>surgically scarred uterus from her prior c-section, I would advocte
>cervical ripening under close monitoring.
>
> We are having difficulty deciding if this is a wise or a poor
>>decision. In addition, if we were to wait an additional week and labor
>>did not progress, would it then be less risky(at 43.5 wks) to go
>>straight to a C section?
>
>You mean 42.5 (41.5 + one week)?? It depends on what her cervix is doing
>-- if dates are really good and her cervix is still unripe and the baby
>is not down in the pelvis, it might be better to just go ahead witha
>repeat c-section. Lots of factors have to be taken into consideration.
>
>--
>M. Kelly Shanahan, MD, FACOG
>S. Lake Tahoe, CA
>
>Replies are for educational purposes only and do not construe any doctor-patient relationship; they do not take the place of a face-to-face consultation with your own doctor.
>Sorry, but personal e-mails will not be answered, due to time constraits and the desire to spend as much free time as possible with my husband and baby daughter
>

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