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



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