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Luigi Raio, MD responds to Gastaldo
Here's the URL for my first Open Letter to Luigi Raio, MD...
MRI before all births? (also: Operative vaginal delivery) http://groups.yahoo.com/group/chiro-list/message/2134 Luigi kindly replied to "MRI before all births?": "Dear Todd...Its nice of you having send me this mail but I must confess, that I am not able to understand the exact meaning of what you have written to me. However, I have serious doubts that MRI is usefull to predict dystocia and I suggest you to read our article that has been recently published!...MR imaging pelvimetry: a useful adjunct in the treatment of women at risk for dystocia? Sporri S, Thoeny HC, Raio L, Lachat R, Vock P, Schneider H. AJR Am J Roentgenol. 2002 Jul;179(1):137-44." I now respond with a second Open Letter... OPEN LETTER #2 to Luigi (archived for global access***) Luigi Raio, MD Department of Obstetrics and Gynecology University of Berne-Inselspital Effingerstrasse 102 3010 Berne SWITZERLAND Luigi, Thanks for the speedy reply. I read the Pubmed abstract of your July 2002 article. There was no mention of sacroiliac motion. Regarding MRI prediction of dystocia... REMEMBER: The fetus is the best pelvimeter and... MRI determination of sacroiliac motion would only HELP predict shoulder dystocia - assuming sacroiliac motion is denied as it usually is (medicine's most frequent delivery positions - semisitting and dorsal - deny sacroiliac motion). Please note: After your July 2002 article was published, two other MRI studies were published - and neither of them measured maximal sacroiliac motion... Here is the relevant excerpt of "Flip women over..." - the post I mentioned in my first Open Letter to you... BEGIN excerpt Flip women over, reach in vagina, *pull* on sacrum during MRI! http://groups.yahoo.com/group/chiro-list/message/2012 BREECH BABY: IS PLANNED CAESAREAN SAFER? OPEN LETTER (archived for global access***) Prof. Jim Thornton Editor-in-Chief British Journal of Obstetrics and Gynaecology/BJOG 27 Sussex Place London NW1 4RG To the Editor: Rietberg et al. [1] offer evidence that term-breech-presentation-planned caesareans may prevent a "twofold increase in mortality, a sevenfold increase in low Apgar score and a threefold increase in birth trauma" (relative to breech vaginal deliveries or breech emergency caesareans). Rietberg et al. did not mention birth position. Nordström [2] writes, "The standard maternal position during the second stage is lying on her back" - yet there is clinical and x-ray evidence (summarized by Gastaldo [3]) that "lying on her back" and semisitting delivery positions close the birth canal significantly. Michel et al. [4] offer magnetic resonance imaging evidence that "lying on her back" and semisitting delivery positions close the birth canal significantly. If the Rietberg et al. study included term breech vaginal deliveries (woman "lying on her back" or semisitting), some of the adverse outcomes may have derived - not from vaginal delivery - but from birth canals senselessly being closed significantly due to medicine's irrational birth behavior. Dr. Todd Gastaldo 22115 NW Imbrie Dr. #338 Hillsboro, Oregon USA References 1. CCTh Rietberg, PM Elferink-Stinkensb, R Brandc, AJ van Loond, OJS Van Hemele, GHA Visserf, Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33,824 infants Br J Obstet Gynaecol 110 (2003), pp. 604-609., 2. L Nordström, Letter (Fetal and maternal lactate increase during active second stage of labour), Br J Obstet Gynaecol 110 (2003), pp. 85 3. TD Gastaldo, Letter (Labor posture), Birth 19 (1992), p. 230. 4. SC Michel, A Rake, K Treiber, B Seifert, R Chaoui, R Huch, B Marincek, RA Kubik-Huch, MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions. AJR Am J Roentgenol. 179 (2002), pp. 1063-1067. MRI SEX - AGAIN... Copied to: Michel et al. (just cited) via... Rahel A. Kubik-Huch, MD Department of Radiology Kantonsspital Baden CH-5404 Baden Switzerland Rahel, My October 2002 usenet article "MRI sex" (which I copied to you) included a brief discussion of your 2002 MRI study (reference 4 above, SC Michel, A Rake, K Treiber, B Seifert, R Chaoui, R Huch, B Marincek, RA Kubik-Huch, MR obstetric pelvimetry: effect of birthing position on pelvic bony dimensions. AJR Am J Roentgenol. 179 (2002), pp. 1063-1067)... http://groups.google.com/groups?hl=e...lm=KInn9.8739% 24OB5.866576%40newsread2.prod.itd.earthlink.net You and your colleagues [Michel et al 2002] indicated that allowing women to birth semisitting or on hands and knees "significantly expands female pelvic bony dimensions, suggesting facilitation of labor and delivery." You failed to mention that it is the uterus (and abdominal musculature) pushing the baby out that likely most significantly expands female pelvic bony dimensions. You failed to reach into the vagina and pull on the sacral tip in your semisitting and hands and knees images. Even so, it is remarkable that you were able to report: "With patients in the hand-to-knee and squatting positions, the sagittal outlet (11.8 ± 1.3 cm and 11.7 ± 1.3 cm) exceeded that in the supine position (11.5 ± 1.3 cm; p = 0.002 and p = 0.01, respectively)..." Just now - in composing my Open Letter response to the Reitberg et al. breech study - I found a 2003 MRI study which you co-authored with Keller et al.: TM Keller, A Rake, SCA Michel, B Seifert, G Efe, K Treiber, R Huch, B Marincek, RA Kubik-Huch, Obstetric MR Pelvimetry: Reference Values and Evaluation of Inter- and Intraobserver Error and Intraindividual Variability. Radiology 2003;227:37-43. I do not agree that you "confirmed that pelvimetric dimensions are significantly smaller in women undergoing cesarean section and assisted delivery than in those delivering vaginally." [Keller 2003] ....at least not in regard to sagittal pelvic outlet diameter. I say this because your study [Keller 2003] was, in large part, a retrospective study of "MR pelvimetry...performed with the patient in the supine position." Women in the supine position are lying on their sacra, closing their birth canals. See below. MASSIVE PELVIC OUTLET AREA DENIED... You failed to mention sacroiliac motion in both studies - yet it is sacroiliac motion which yields a "massive" change in sagittal pelvic outlet dimension. This "massive" amount of sacroiliac motion denied was noted in the 1969 article by JGB Russell which you and your colleagues cited in both of your MRI studies... Incidentally, "massive" was the word used by another group of researchers (Lilford et al.) who knowingly (or perhaps negligently) perpetrated a radiation fraud on the recent parturients they studied. See Gastaldo to delight BJOG editor Thornton http://groups.google.com/groups?hl=e...lm=hCIKa.13893 %24C83.1321663%40newsread1.prod.itd.earthlink.net Given these rather major gaffs - I no longer believe your 2002 statement that "ethical grounds" prohibited you from studying "recent parturients" in 2002. I believe that you INTENTIONALLY failed to study "recent parturients" - to help in the ongoing cover-up of a MASSIVE medical crime against mothers and babies... Here is the relevant "ethical grounds" quote from your 2002 study: "A limitation of our study is that we included no pregnant women. We made this decision for two reasons: the limited space in the scanner bore (upright scanning is technically impossible for a woman in late pregnancy) and the ethics of scanning stress, particularly in the hand-to-knee and squatting positions (even nonpregnant volunteers were exhausted by having to remain immobile during the 10 min. of image acquisition). On these ethical grounds, we even extended our noninclusion criteria to recent parturients...We are aware that this limitation prevented us from measuring the influence of pregnancy-related joint laxity in late gestation, for which there is ample documentation. However, changes in pelvic dimensions observed in nonpregnant women should become even more pronounced during delivery..." [Michel et al. Am J Roentgenol 2002 Oct;179(4):1063-1067] Yes, Rahel, changes in pelvic dimensions SHOULD become even more pronounced during delivery - and in recent parturients - but NOT just because of increased ligament laxity. You failed miserably in your clinical purpose: "The clinical purpose of our study was to provide obstetricians with guidance in predicting fetal-pelvic disproportion..." I say again: You failed to mention in your 2002 study that it is the uterus (and abdominal musculature) pushing the baby out that likely most significantly expands female pelvic bony dimensions. And you failed to reach into the vagina and pull on the sacral tip in your semisitting and hands and knees images. Your 2003 study helps MDs pretend (with Lilford et al.) that massive amounts of sacroiliac motion aren't being denied by MDs. Your 2003 study did contain this HOT quote: "In choosing the mode of delivery, it is important to be able to test for fetal-pelvic disproportion, since fetomaternal morbidity and mortality increase with prolonged labor..." Yes, PLEASE DO test for fetal-pelvic disproportion! Reach in the vagina and pull on the sacral tip and compare that AP pelvic outlet diameter with the AP pelvic outlet diameter obtained with the mother lying on her sacrum. "Fetomaternal morbidity and mortality increase with prolonged labor" - was the EXACT point I was trying to make to BJOG Editor Jim Thornton recently! Jim IGNORED this point! See again: Gastaldo to delight BJOG editor Thornton http://groups.google.com/groups?hl=e...lm=hCIKa.13893 %24C83.1321663%40newsread1.prod.itd.earthlink.net You also wrote in your 2003 study: "[P]elvimetric differences of just a few millimeters could have an important bearing on obstetric decision making..." YES! If the OB is senselessly closing the birth canal up to 40 millimeters - you STOP him/her! In some births, OBs are senselessly closing the birth canal MORE than 40 millimeters - at least this is what is indicated by the 2001 issue of Williams Obstetrics, as in, "...With increasing narrowing of the pubic arch, the occiput cannot emerge directly beneath the symphysis pubis but is forced increasingly farther down...the ischiopubic rami. In extreme cases, the head must rotate around a line joining the ischial tuberosities [!] (p. 438)..." You failed to mention the pubic arch! Here is a 1913 quote regarding the effect of the pubic arch: "[M]oving backward of the tip of the sacrum...enlarges the available space not merely directly in proportion to the distance backward, but more nearly by the square of that distance." [Emmons, AB. A study of the variations in the female pelvis, based on observations made on 217 specimens of the American Indian squaw. Biometrika 1913; 9:34-47.] Again quoting Williams Obstetrics: When the pubic arch is extremely narrow, "the head must rotate around a line joining the ischial tuberosities [!] (p. 438)..." RUSSELL STARTED THE GAME... Russell mentioned the intrapartum x-ray study of Borell and Fernstrom in his 1969 study - but NOT in his 1982 study... Russell also suggested (fraudulently) that semisitting widens "all the diameters." Assuming that you guys actually read the 1969 paper by Russell (which you cited in both MRI studies), you are either dumb or scum. I personally think you guys are scum. You gave as a reason for your study: "We believed it important to establish reference MR pelvimetric values"; when in fact, you used MRI like Liford et al. used x-ray - to CONCEAL "pelvimetric values." You concealed MASSIVE "pelvimetric" values to quote Lilford et al.'s bogus study which attempted to conceal the value of previous x-ray and clinical observations.) Sorry to call you all scum. Perhaps some of you simply *weren't aware* of the obvious ongoing obstetric criminal negligence discussed herein? Perhaps you never read my email - or the relevant medical literature? Well now you *are* aware. PLEASE help stop MDs and MBs and nurses and midwives from closing birth canals up to 30%. END excerpt Flip women over, reach in vagina, *pull* on sacrum during MRI! http://groups.yahoo.com/group/chiro-list/message/2012 PREGNANT WOMEN: MDs and MBs (and midwives) are senselessly closing birth canals up to 30%... It's EASY to allow your birth canal to OPEN the "extra" up to 30% (!)... (and you DON'T have to squat) Just roll onto your side as you push your baby out. BUT - see WARNING, WARNING, WARNING below... Ladies, make sure you are NOT on your butt/back when the MD pulls out her/his vacuum extractor or forceps because... MD-OBSTETRICIANS ARE VACUUMING BABIES OUT OF VAGINAS - WITH BIRTH CANALS SENSELESSLY CLOSED! UP TO SIX BABIES PER DAY *DIE* FROM VACUUM-ASSISTED SPINAL MANIPULATION! See my first Open Letter to Luigi, URL above... PREGNANT WOMEN! It's EASY to open your birth canal the "extra" up to 30%! Just roll onto your side as you push your baby out! PLEASE talk to your MD about this NOW... WARNING WARNING WARNING WARNING: Some MDs will let women "try" side-lying and other "alternative" delivery positions - but they will move women back to semisitting - close their birth canals (!) at the very worst possible moment (as the baby is coming out)... See GASTALDO'S ABSTRACT - my invited poster presentation at a recent obstetric congress co-sponsored by the American College of Obstetricians and Gynecologists/ACOG. (NOTE: GASTALDO'S ABSTRACT is on the web: Search "GASTALDO'S ABSTRACT Paciornik"...) As always, I am in favor of pardons in advance for MDs. MDs are just academic prime cuts forced through this culture's most powerful mental meatgrinder - medical school. Same goes for MBs... As with my first Open Letter to Luigi - this letter too is being copied to... Magnetic Resonance Spectroscopy and Methodology - Department of Clinical Research - University Bern/Switzerland Chris Boesch, Professor, MD PhD Roland Kreis, Assistant Professor, PhD Peter Vermathen, Research Assistant, PhD Michael Ith, PhD, MD/PhD Student Karin Zwygart-Brügger, MTRA Christian Salvisberg, Dipl.El.Ing.FH Monica Zehnder, Dipl.Turn & Sportlehrerin II ETH Verena Beutler, MTRA Elisabeth Giger, teacher and diploma student of psychology and the team at the MR Center of the University and Inselspital Bern (together with Institute of Diagnostic Radiology) Sonia Zoula, PhD (member of Department of Diagnostic Radiology, associate member of AMSM) Former Staff (2001-) Lucie Hofmann, PhD Bruno Jung, Engineer, Dipl.El.Ing.HTL (email addresses listed at http://www.cx.unibe.ch/dkf1/amsm/staff-0.htm) Thanks for reading, everyone, Sincerely, Todd Dr. Gastaldo ***This Open Letter will be instantly archived for global access at http://groups.yahoo.com/group/chiro-list/message/2136 Within 24 hours it will be in the google archive. Search http://groups.google.com for "Luigi Raio, MD responds to Gastaldo" |
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