Re: Clinical scenario
From: art fougner, md (evsono@pipeline.com)
Mon Oct 9 08:34:14 2006
This patient is in labor ... manage as such.
Art
At Sun, 8 Oct 2006, Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>
>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
>
>a. call her in labor and deliver her now.
>b. Wait for her to actually go into 'labor' since she is
>technically preterm
>c. Amnio her and deliver if mature
>d. Give her steroids and deliver in 48 hours
>e. 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
>
>//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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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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