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Thread: Using ultrasounds to determine gestational age could result in baby's death

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  1. #1
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    Using ultrasounds to determine gestational age could result in baby's death


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    Irritates the heck out of me when due dates are changed because of 2nd trimester ultrasounds. It's like changing a kid's graduation date from school based on how tall he is.

    First trimester ultrasound is VERY accurate at figuring out due dates because the structural features appear in a very consistent way and at a very consistent rate across all embryos. Second trimester ultrasound is way too dependent on genes and mom's diet.
    Liz.

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    I'm not sure I really get it. Doctors aren't generally going to actively try to prevent or stop labor if you're reasonably close to your due date.

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    What Lizch said... And I'm surprised there are many docs who base any guess at fetal age on a second trimester ultrasound rather than factoring in your period or an earlier ultrasound.

    I mean, what... Are all these women only appearing at the doc office during trimester 2?

    Either way it's not the ultrasound "resulting" in the baby's death like the article says. It's babies who run late, and are allowed to do so, who are more likely to die regardless. But there are plenty of women with accurate due dates who choose to wait for the baby even if late...

    Avocado, right -- I guess the risk here is from docs not inducing labor? Still surprises me considering the recent trend seems to be to induce on the due date, not letting them go way over, unless the parents really insist otherwise. So even if they misjudged by two weeks they'd still be within the normal plus or minus two week window...
    Last edited by Jenny; 09-28-2010 at 06:59 PM.
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    I didn't think they were generally inducing labor simply based on date calculations. They do start monitoring closely when going past term. But inducing is generally based on detecting distress, not calculated dates.

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    Oh Avocado, how I wish that were true!!! The induction rate at our local hospital is 40%. 40% of their babies are not in distress. Doctors have been routinely inducing at 37+ weeks for reasons that research does not back up, ranging from "big baby" (inducing does not give the pelvis its natural relaxing hormones that enable it to flex, so it's harder to push a baby through it....it would be better to wait for natural labor even if the baby gets a big bigger, so the pelvis can flex) to "low fluid" (tenuous evidence at best) to "why not? I'm not on call next week, so let's get the baby out now."

    I think the trend will reverse soon because induction is linked to higher c-section rates, and because inducing prior to 39 weeks greatly increases the risk that the baby will go straight to NICU instead of mom's arms
    Liz.

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  7. #7
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    Quote Originally Posted by lizch View Post
    Oh Avocado, how I wish that were true!!! The induction rate at our local hospital is 40%. 40% of their babies are not in distress. Doctors have been routinely inducing at 37+ weeks for reasons that research does not back up, ranging from "big baby" (inducing does not give the pelvis its natural relaxing hormones that enable it to flex, so it's harder to push a baby through it....it would be better to wait for natural labor even if the baby gets a big bigger, so the pelvis can flex) to "low fluid" (tenuous evidence at best) to "why not? I'm not on call next week, so let's get the baby out now."

    I think the trend will reverse soon because induction is linked to higher c-section rates, and because inducing prior to 39 weeks greatly increases the risk that the baby will go straight to NICU instead of mom's arms
    I'd like to see the research that made you come to this conclusion. I'm a Respiratory Therapist that is there for deliveries week in and week out. The original article is correct that allowing a mom to carry a baby late is bad as many of these kids wind up with Meconium in the fluid. If the baby breathes that Meconium (baby poop is what it is) in, they usually wind up with Pneumonitis and several days in the hospital.

    Babies born in the 36 to 38 week window generally do just fine. That pelvis flex idea is also sheer nonsense. Pitocyin is given to induce labor, but the moms hormones are also in play and not damped down by it. If the baby is too big, it's just too big. Trying to force a big baby out usually results in a severe deceleration of the baby's heart rate which in turn can lead to hypoxia with a limp, blue baby being born. I know, I've seen it.

    And the idea that docs go for C-Sections as a matter of convenience is a gross overgeneralization. Every Friday night (I work 6p to 6:30a) for the last six weeks I've had a delivery between 3 and 5 a.m. when the team (including the docs) all had to be called in--four of them C-Sections from failure to progress. The docs didn't induce, the docs went home and the moms wound up not progressing and THEN the C-Section was done.

    The OP is a good article that is right in line with what I see every week.

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    I'm amazed the message about not inducing/doing c-sections prior to 39 weeks unless absolutely necessary has not reached the respiratory therapist community! You're in a position to put pressure to change this.

    http://www.ajog.org/article/S0002-93...073-6/fulltext

    The pelvis flex notion is not even remotely nonsense. Why do you think you can pour pitocin into a mom's veins at 36 weeks pregnant, and get nowhere, if pitocin is all it takes? There's a whole orchestra of hormones that precede oxytocin, including prostaglandins and relaxin.

    Pushing a big baby out "usually" results in decels? That's not the major concern with big babies. I've seen 10-11lb babies born without a single decel and 6lbers decel'ing like crazy. The concern with big babies is primarily shoulder dystocia, and even ACOG is lukewarm about induction for macrosomia as a solution to that.

    Yes, there are dangers in waiting too long for birth to happen naturally, including meconium aspiration, SGA, and stillbirth. But there are also risks to birth being forced prior to 39 weeks, whether you want to believe it or not.
    Liz.

    Zone diet on and off for several years....worked, but too much focus on exact meal composition
    Primal since July 2010...skinniest I've ever been and the least stressed about food

  9. #9
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    Quote Originally Posted by lizch View Post
    I'm amazed the message about not inducing/doing c-sections prior to 39 weeks unless absolutely necessary has not reached the respiratory therapist community! You're in a position to put pressure to change this.

    http://www.ajog.org/article/S0002-93...073-6/fulltext

    The pelvis flex notion is not even remotely nonsense. Why do you think you can pour pitocin into a mom's veins at 36 weeks pregnant, and get nowhere, if pitocin is all it takes? There's a whole orchestra of hormones that precede oxytocin, including prostaglandins and relaxin.

    Pushing a big baby out "usually" results in decels? That's not the major concern with big babies. I've seen 10-11lb babies born without a single decel and 6lbers decel'ing like crazy. The concern with big babies is primarily shoulder dystocia, and even ACOG is lukewarm about induction for macrosomia as a solution to that.

    Yes, there are dangers in waiting too long for birth to happen naturally, including meconium aspiration, SGA, and stillbirth. But there are also risks to birth being forced prior to 39 weeks, whether you want to believe it or not.
    C-Sections, I'd agree with you on that. And as for Pit, what I said is that it doesn't damp down or eliminate the mothers natural hormones. I'm well aware of the prostaglandin cascade and relaxin, both of which still occur when labor is artificially induced which in turn means that mom is all set and ready to deliver.

    As as for the big babies and shoulder dystocia, all you're doing is trying to sidetrack the issue again. In your post, you decried having a C-section done because of the 'excuse' of a big baby. Big babies can be a real problem, and if there are decels or failure to progress, you need to take the baby by C-Section. There is also a formula for evaluating the size of the birth canal vs. the size of the baby to determine whether an elective C-section is advised. That evaluation is quite accurate, and given the low risks of a C-Section as weighed against the danger to mother and baby, most moms choose to go with a C-Section. And yes, it is a choice!

    And as for risks before 39 weeks, there are risks involved in childbirth to both mom and baby no matter how many weeks along they are! But, I've been in on the deliveries of many babies in the 36-38 week area and from my experience, it's rare to have a problem. Usually, the problems that occur in that period of time would have occurred anyway. We just had a baby born with a neoblastoma at 37 weeks---delaying for two or three more weeks wouldn't have changed the outcome.

  10. #10
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    Yeah, judging by what many other new moms tell me, the local trend is to not let you go more than a couple days past your due date unless you insist -- due to the same concerns listed in the article.

    My OB won't induce early as Lizch describes above, but considering the trouble my 10 pound baby gave me, I wish they had!

    Avocado, seems like if they detect distress they'll send you straight in for a c-section... Not induce labor.

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