Re: Clinical scenario
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Oct 9 08:32:42 2006
Uterine contractions, in this case, subclinical, producing cervical
dilation... that's labor...IMHO.
Ef
>
At Mon, 9 Oct 2006, Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>
>I will beg forgiveness and tell you that when she was 4-5cm MY instinct was to have her delivered. Unfortunately, I wasn't the back-up for the midwife at that point and others have different feelings.
>
>Again, for sake of argument, what defines 'labor' in this case? The fact that she hasn't had regular contractions is what was used to keep her admitted, rather than deliver her. Others argued that amniotomy was a form of augmentation of labor and is against ACOG guidelines for electively inducing someone less than 39 weeks, thinking that if by being 8cm was truly 'active labor' that she would keep going on her own without an amniotomy.
>
>//SIGNED//
>
>D. Glen Elrod, Maj., USAF, MC
>
>Obstetrician/Gynecologist
>
>Chief of Obstetrics
>
>48 MDOS/SGOBO
>
>RAF Lakenheath, England
>
>Telephone DSN: 314-226-8130
>
> Comm: +44 (0) 1638 52 8130
>
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>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of rmodugno@aol.com
>Sent: Sunday, October 08, 2006 7:10 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Clinical scenario
>
>-----Original Message-----
>From: Darryl.elrod@LAKENHEATH.AF.MIL
>To: ob-gyn-l@dns.obgyn.net
>Sent: Sun, 8 Oct 2006 12:26 PM
>Subject: Clinical scenario
>
> I thought I'd ask a clinical question to get away from the Op
>Ed debate for a bit.
>
>
>
> 28 yo G2P1 shows up to our midwife at 36+2 wks for her GBS testing.
>Her last delivery was at 37 wks and she is feeling a bit of pressure.
>No regular contractions, just some irregular cramping. She happens to
>live about 30 minutes from the hospital. On exam the midwife finds
>that she is 4-5cm/75% and -2 station.
>
>
>
> Given the history of preterm delivery, the distance from the hospital
>she admits her to the ward.
>
>
>
> The next morning, still no regular contractions but is checked again
>and is 5-6cm. She doesn't appear to be 'actively' in labor so we sit
>tight.
>
>
>
> Hospital day 2 (now 36+4) she is checked again and is 6-7cm. The next
>morning at 36+5 she is 8cm but still no regular contractions, no
>bleeding, no leaking fluid.
>
>
>
> We have a group discussion about her care and come up with several
>different options.
>
>
>
> For sake of argument, who would
>
>
>
> * call her in labor and deliver her now.
> * Wait for her to actually go into 'labor' since she is technically
>preterm
> * Amnio her and deliver if mature
> * Give her steroids and deliver in 48 hours
> * Deliver her at 39 weeks if she is still pregnant, but keep her
>admitted until then.
>
>
> Hope this spurs some debate of a different kind.
>
>
>
> Glen
>
> ************************************************************
>
> ************************************************************
>It certainly should Glen. 2 days in hospital for something that should
>take a few hours to do! She shoulda been home with her baby by now!
>
>Get the lead out, and deliver her after the amniotomy. ;+)
>
>Robert Modugno MD MBA FACOG
>Sylva, North Carolina.
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
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