Re: your findings
From: zalel (zalel_y@netvision.net.il)
Fri Aug 23 23:02:48 2002
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Hellow!
Ragarding what Dr. Bereck has written- it is true that VBAC (post one or
more CS) is dangerous for both the mother and the fetus. However, there are
some facts worse mentioning- The main risk for uterine rupture is after
INDUCTION of labor by prostaglandins. The risk is much lower when the VBAC
is spontaneously and not induced!!
Regarding the prediction by ultrasound- there some works dealing with
measuring the uterine thickness after CS and predicting rupture when the
measurement is below 4 mm. I personally don't believe it is useful- although
I measure it whenever they ask for it in the Department, the prediction is
very low.
Best regards,
Yaron Zalel, MD
-------Original Message-------
From: ultrasound@obgyn.net
Date: éåí ùéùé 23 àåâåñè 2002 20:32:11
To: Multiple recipients of list ULTRASOUND
Subject: Re: your findings
There is no data to suggest that ultrasound can
predict the risk of uterine rupture with attempted
VBAC with any accuracy or clinical usefulness. The
risk of VBAC (particularly after 2 c-sections) is two
fold: to the baby (1:200 at a minimum risk of uterine
rupture with high fetal mortality) and to the mother
(higher risk of major complications with attempted
VBAC), both of these facts are based on large studies
published in the past few years in the New England
Journal of Medicine, that is, not anecdotal. Let me
tell you -- uterine rupture is one complication you
really want to avoid. I would typically encourage my
patients to undergo another c-section.
--
-- Dave Berck, MD, MPH, RDMS
--- Teresa Hudson <btehudson@worldnet.att.net> wrote:
>
> Hello,
> I find this information very interesting. I asked
> my midwife if there was way that we could determined
> uterine wall thickness and she told me no. That's
> why I find this info very enlightening. Was
> wondering if you could send me this information via
> mail so I could pass it on to my midwife. I am
> expecting with child no.3 and want undergo a trial
> of labor. I have had two prior C-sections. One was
> for failure to progress at the expected rate and the
> other one was for a cord problem that occurred
.
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<DIV>Hellow!</DIV>
<DIV> </DIV>
<DIV>Ragarding what Dr. Bereck has written- it is true that VBAC (post one
or more CS) is dangerous for both the mother and the fetus. However, there
are some facts worse mentioning- The main risk for uterine rupture is
after INDUCTION of labor by prostaglandins. The risk is much lower when
the VBAC is spontaneously and not induced!!</DIV>
<DIV>Regarding the prediction by ultrasound- there some works dealing with
measuring the uterine thickness after CS and predicting rupture when the
measurement is below 4 mm. I personally don't believe it is useful-
although I measure it whenever they ask for it in the Department, the
prediction is very low.</DIV>
<DIV> </DIV>
<DIV>Best regards,</DIV>
<DIV> </DIV>
<DIV>Yaron Zalel, MD</DIV>
<DIV> </DIV>
<DIV id=IncrediOriginalMessage><I>-------Original Message-------</I></DIV>
<DIV> </DIV>
<DIV id=receivestrings>
<DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>From:</B></I> <A
href="mailto:ultrasound@obgyn.net">ultrasound@obgyn.net</A></DIV>
<DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>Date:</B></I> éåí ùéùé 23
àåâåñè 2002 20:32:11</DIV>
<DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>To:</B></I> <A
href="mailto:ultrasound@mail.medispecialty.com">Multiple recipients of
list ULTRASOUND</A></DIV>
<DIV dir=ltr style="FONT-SIZE: 11pt" <i><B>Subject:</B></I> Re: your
findings</DIV></DIV>
<DIV> </DIV>There is no data to suggest that ultrasound
can<BR>predict the risk of uterine rupture with attempted<BR>VBAC with any
accuracy or clinical usefulness. The<BR>risk of VBAC (particularly after 2
c-sections) is two<BR>fold: to the baby (1:200 at a minimum risk of
uterine<BR>rupture with high fetal mortality) and to the mother<BR>(higher
risk of major complications with attempted<BR>VBAC), both of these facts
are based on large studies<BR>published in the past few years in the New
England<BR>Journal of Medicine, that is, not anecdotal. Let me<BR>tell you
-- uterine rupture is one complication you<BR>really want to avoid. I
would typically encourage my<BR>patients to undergo another
c-section.<BR><BR>-- Dave Berck, MD, MPH, RDMS<BR><BR><BR><BR>--- Teresa
Hudson <<A
href="mailto:btehudson@worldnet.att.net">btehudson@worldnet.att.net</A>>
wrote:<BR>><BR>> Hello,<BR>> I find this information very
interesting. I asked<BR>> my midwife if there was way that we could
determined<BR>> uterine wall thickness and she told me no.
That's<BR>> why I find this info very enlightening. Was<BR>>
wondering if you could send me this information via<BR>> mail so I
could pass it on to my midwife. I am<BR>> expecting with child no.3 and
want undergo a trial<BR>> of labor. I have had two prior C-sections.
One was<BR>> for failure to progress at the expected rate and
the<BR>> other one was for a cord problem that occurred<BR>.</TD>
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