Friday, January 14, 2011

More exchanges with Dr. Rozenberg

Here are other questions I sent Dr. Rozenberg that relate to this measurement, and his responses. They provide additional information on the measurement as well as his thoughts as to its helpfulness in predicting uterine rupture. Start at the bottom and work your way up.

#4 - Second Response from Dr. Rozenberg

Dear [Me]
1)"There have been other studies on this topic [other than yours] and not all are so favorable".
> I disagree with this assertion. I enclose you a recent review of studies about this topic. all are corresponding; however, most have biases.

2)"A uterine scar could be thick at 37 weeks and thin at 39 weeks. For that matter, it could be thick at the onset of labor but thin two hours later."
> I agree with it. however, our study showed that when the low uterine segment was thick around 37 weeks, the risk of uterine rupture during a trial of labor was very low. Moreover, most of thin low uterine segments are not pathologic. In all, in order to help you to understand :
- when the low uterine segment is thick around 37 weeks, it is usually strong
- when the low uterine segment is thin around 37 weeks, you can not correctly predict the issue.

I hope that my explanations will help you to understand. Give me news when you will be delivered (or before if you have any other questions)
sincerely
patrick

#3 - Second Email to Dr. Rozenberg

Dear Dr. Rozenberg,

A few months ago I emailed you about your studies regarding the connection between the thickness of the LUS and a patient's chances of uterine rupture during a VBAC attempt. I believe, at the time, I emailed and thanked you for your prompt and informative responses, and I'd like to do so again now. If you don't mind indulging me one last time, I'd like to ask you one more question.

After corresponding with you, I asked an American doctor, Bruce Flamm, who has published books and articles on VBAC over here, why most American doctors don't perform a LUS measurement on their VBAC patients. His response was this: "There have been other studies on this topic [other than yours] and not all are so favorable. A uterine scar could be thick at 37 weeks and thin at 39 weeks. For that matter, it could be thick at the onset of labor but thin two hours later."

My question is, do you agree with this? I am just a layperson, of course, but I have read many other studies (accessed through online journal banks like Pub Med) and they all suggest that women with a prior cesarean section scar, on average, consistently have thinner LUS segments than women with unscarred uteruses. So, I'm tempted to think his response is incorrect, but I wanted your opinion.

Thanks again,
[Me]

#2 - Dr. Rozenberg's Response
Dear Leigha

> My question is, do you still believe this finding is accurate?
Yes, I do and we practice this examination in our department before deciding on the mode of delivery with our patients

>If so, why don't more doctors do sonograms to measure this when they have a VBAC candidate?
I think that most obstetricians feel uncomfortable with the perspective of legal suits in rare cases of uterine rupture in case of trial of labour and prefer to perform repeat Cesarean Sections. Even in France, the LUS measurement is rarely performed.

Sincerely yours
Patrick

#1 - My first email to Dr. Rozenberg

Dear Dr. Rozenberg,

My name is [Me].... I am writing you because I had a cesarean section with my first child in December 2004 because she was breech, and I am contemplating getting pregnant again soon. I have been researching in-depth the possibility of having a VBAC with my next baby. In doing his search, I found an article you wrote in 1996 on how measurements of a woman's lower uterine segment in the third trimester can predict whether she will suffer a uterine rupture during a trial of labor. Specifically, your article showed that women with a measurement of over 3.5mm are almost guaranteed not to rupture. This is of great interest to me because, like many other potential VBAC candidates, I am afraid to try a VBAC for fear of having a uterine rupture. My question is, do you still believe this finding is accurate? If so, why don't more doctors do sonograms to measure this when they have a VBAC candidate? What can I say to my doctor (who I don't think does this type of measurement) to get him to do it when I'm pregnant? I'm
pretty convinced by your findings that I want this type of measurement done but it just doesn't seem to be done that commonly over here.

Any advice/encouragement/information is appreciated.

[Me]

3 comments:

Rusty Bellies Blog said...
This comment has been removed by the author.
Rusty Bellies Blog said...

I am 38 weeks pregnant and recently had a LUS scan done. I was told my scar was too thin to attempt HBAC, however nowhere on my scans can I find the measurement that the OB is referring too. Your blog has been a great resource to me. Thanks for sharing.

Sapreena Lewis said...

Leigha thanks for sharing. Your blog is a big help. I am much more confident now and will push for VBAC