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January 25, 2006

A Woman With Fetal Loss

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(4):386-387. doi:10.1001/jama.295.4.386-a

To the Editor: In the Clinical Crossroads article by Dr Sachs,1 a tragic event resulted in a candid inquiry into the management systems in place for delivering care on the labor floor. However, I am concerned about the decision-making process that led to the initiation of the care for this patient. I believe that the clinical algorithm calling for induction of labor should have first pointed toward termination of pregnancy and then to a decision on the method to use. The brief clinical description was consistent with conditions that were quite unfavorable for successful and safe induction of labor. The ultrasound to evaluate fetal well-being in addition to clinical evaluation by 2 different attending physicians must have given a clue to the presence of a macrosomic fetus whose stillborn weight was 10 lb (4530 g). Elective cesarean delivery should have been the choice in the face of strong relative contraindications to the induction of labor. Dr Sachs had little reservation in recommending cesarean delivery when a nonreassuring fetal heart rate became apparent. The antepartum evaluation should warrant similar consideration.

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