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Re: Clinical scenarioFrom: babycatchers@aol.comMon Oct 9 09:47:26 2006
Around our neck of the woods, the OB would have probably rutured her at 6 cm and let her go from there. We don't stop dilation after 35 weeks. We are very rural, so he doesn't like to take a chance on her not getting back here. (Very curvy mountain roads, so 30 miles might take and hour). The OB's philosphy is "If labor is happening, there must be a reason that baby needs out of there- after 35 weeks. The pediatricians are not pleased until the 36 week mark, but after that, they agree with that management. Treat GBS as positive abd give one dose before ROM and don't rupture until close to time for the 2nd dose- that also keeps the peds happy. West Virginia Vicki Smith, CNM -----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 //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 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer. Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="utf-8"
Around our neck of the woods, the OB would have probably rutured her at 6 cm and let her go from there. We don't stop dilation after 35 weeks. We are very rural, so he doesn't like to take a chance on her not getting back here. (Very curvy mountain roads, so 30 miles might take and hour).
The OB's philosphy is "If labor is happening, there must be a reason that baby needs out of there- after 35 weeks.
The pediatricians are not pleased until the 36 week mark, but after that, they agree with that management.
Treat GBS as positive abd give one dose before ROM and don't rupture until close to time for the 2nd dose- that also keeps the peds happy.
West Virginia
Vicki Smith, CNM
-----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
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
Notice of Confidentiality
Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer.
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