Dear David,
Can you please explain further your statement that the Guide to Effective
Care statement and other research you stated below are not relevant to this
argument?
Kind regards,
Toni
>From: "David Simon" <[EMAIL PROTECTED]>
>To: "ozmid" <[EMAIL PROTECTED]>
>Subject: second twin
>Date: Sat, 18 Aug 2001 09:56:04 +1000
>
>Jan and Robin
>I don't think you should trivialise the concerns of the registrar in regard
>to the second twin, but equally, a discussion should be able to take place
>without personal attack. Neither the Effective Care statement on elective
>caesar vs vaginal birth for twins, nor the various studies on the relative
>merits of caesar versus internal version and breech extraction for the
>non-vertex second twin is relevant to this debate.
>The registrar is concerned about delay in appropriate management if there
>is
>a bradycardia for the second twin. Although there may be no hospital in
>Sydney with a policy of twin birth in theatre, this is certainly a topic
>that would be discussed in most labour wards. This has become more of an
>issue for several reasons over the recent decade or so - 1)decreased
>experience amongst registrars/junior consultants due to increased elective
>caesar rates for twins, decreased working hours, more trainees to share the
>experience around 2) the fact that anaesthetists will no longer give a
>"quick GA" in labour ward to allow breech extraction 3)and the inevitable
>increasing concern around blame for poor outcomes. There has been a high
>profile case in Melbourne surrounding delay in birth of second twin.
>Options would be
>1) A detailed consent form that recognises the potential for delay in
>appropriate management if a complicated manoevre was required for birth of
>the second twin in labour ward
>2) A discussion with the anaesthetic staff to see whether they would be
>happy to put in a spinal in labour ward to allow emergency manoeuvres
>3) Place an epidural catheter in labour, but put in no solution unless
>needed for second twin
>4) Expect only a small chance of problems and explain to the mother that a
>very uncomfortable (but perhaps bearable with nitrous) procedure may
>possibly be needed.
>Jan is right - the chance of problems is small, but especially when there
>has been disagreement about options there can lots of "I told you sos" when
>things don't turn out well.
>David
>
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