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Re: OB: Coding dilemmaFrom: rmodugno@aol.comFri Jan 27 17:46:23 2006
A few thoughts el. What is the survival rate at that State Hospital of 26 weekers? No - a wait of 45 minutes for the resident is not acceptable. 26 week twins with leading twin breech in labor - section in a New York minute. By the way, a team of American plaintiff's attorneys has left J.F.K on their way to Windhoek. Robert Modugno MD MBA FACOG Marietta, GA -----Original Message----- From: Dr Eberhard Lisse <el@lisse.NA> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> Sent: Thu, 26 Jan 2006 22:13:59 -0600 Subject: Re: OB: Coding dilemma I just walked through the maternity ward of the State Hospital (public hospital, NHS type) to my way to the post natal ward to see my private patient, when I noticed a patient fitting post partum. The midwives asked me to help so we rescuscitated the patient successfully. I then proceeded to the post natal ward, when, on the other side of the corridor, I was asked by the next midwive to help, because a 26 week (mainly) unbooked primigravida with twins, footling breech and vertex, was fully dilated and pushing with te cord prolapsed (nd having been replaced by the midwife). Delivered the first very tiny baby and for the first time in my carreer the heads locked. Waited for the contraction to finish and managed to convince the patient not to push, while I displaced the second head upwards so release the entrapped, deflexed head so much I could get to the mouth to deliver. Poor Apgrar of course, but the Pediatric Intern had some Muti and the baby was breathing when I left, eventually. Second baby a bit bigger, Apgar bit better, and I told the Intern to concentrate on this one until her Resident arrived. Probably around 1 kg and they intubated and took to ICU. I would like to hear some opinions about whether you guys consider the first case enough of an emergency to warrant the immediate arrival of a Resident (when requested by an outside Specialist) to take over the patient or if you feel that 45 minutes is appropriate? And in the second case, since the presentations were known whether you (even Bernard :-)-O) would have considered a C/S (6 hours earlier, on admission)? greetings, el -- Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar) el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell) PO Box 8421 \ / Please send DNS/NA-NiC related e-mail Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na
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