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In Reply: Dr Blander argues that the patient should have had an elective cesarean delivery because the stillbirth weight was 10 lb (4530 g). I disagree, as the ability to predict fetal weight is poor.¹ Furthermore, 10 lb (4530 g) is not an indication for an elective cesarean delivery in a patient who is not diabetic.¹

Drs Sander-Prather and De Ruyter raise questions regarding the anesthesia management of this patient. She was given a test dose of anesthetic (3 mL of 1.5% lidocaine with 5 µg/mL of epinephrine) and despite that, she still had a hypotensive episode. This was quite early on in her course and the fetal heart rate fully recovered following placement of the patient in the left lateral position and normalization of her blood pressure. Given this quick recovery, delivery was not considered at that time. Epidural anesthesia was started because both the mother and fetus were . . . [Full Text of this Article]

Benjamin P. Sachs, MD
bsachs@bidmc.harvard.edu
Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
Boston, Mass