Re: Clinical scenario
From: Larry Glazerman (l.glazerman@rcn.com)
Mon Oct 9 10:50:42 2006
Joe:
The way I understand it is "regular cervical contractions causing
progressive dilatation of the cervix."
--
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown, PC
larry.glazerman@lvh.com
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joe
Cutchin
Sent: Monday, October 09, 2006 11:34 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Clinical scenario
Larry: I thought it included "progressive dilatation of cervix" . I am
being picky because this gets into courts ,ie was she in labor or not. Joe C
Larry Glazerman wrote:
> To play devil's advocate, Friedman's data applied to patients who are in
> labor. Labor is defined as regular contractions that cause cervical
> change. The reason that this s a dilemma is that it's not clear that the
> patient is in labor. If she were definitely in labor, there wouldn't be
> a controversy.
>
> Having given up OB a year ago, I don't have an opinion on management,
> just wanted to clarify the semantics of the issue.
>
> Larry R. Glazerman, MD
>
> Ob-Gyn at Trexlertown, PC
>
> larry.glazerman@lvh.com
>
> ------------------------------------------------------------------------
>
> ------------------------------------------------------------------------
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Julio
> ------------------------------------------------------------------------
> Arellano
> Sent: Monday, October 09, 2006 10:47 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Clinical scenario
>
> Dear listmates:
>
> The starting point is to define this patient's status, that is, if she
> is or not in labor. After 5 cm, according with Friedman's partogram, is
> a latent phase of the first stage, which become prolonged if exceeds 20
> hours in the nullipara or 14 hours in the multipara. With GBS risk
> unknow, and so close to the 37 weeks, I agree with El, AROM or oxytocin.
>
> Dr. Julio C. Arellano
>
> La Plata. Bs As. Argentina
>
> arellano@netverk.com.ar <mailto:arellano@netverk.com.ar>
>
> -------Mensaje original-------
>
> De: Elrod, Darryl G Maj 48 MDOS/SGOBO
> <mailto:Darryl.elrod@LAKENHEATH.AF.MIL>
>
> Fecha: 10/08/06 13:30:57
>
> Para: Multiple recipients of list OB-GYN-L <mailto:ob-gyn-l@dns.obgyn.net>
>
> Asunto: 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
>
> 1. call her in labor and deliver her now.
> 2. Wait for her to actually go into 'labor' since she is technically
> preterm
> 3. Amnio her and deliver if mature
> 4. Give her steroids and deliver in 48 hours
> 5. 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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