Re: Clinical scenario
From: arellano@netverk.com.ar
Mon Oct 9 12:42:23 2006
Larry:
Beyond the semantic issue, I think that all we could agree in this point:
any patient (term or preterm) who reach 7 - 8 cm of cervical dilatation is in
labor. Where is the difference? to do it in 3 hours or 3 days.
Just my opinion
Dr. Julio C. Arellano
La Plata. Buenos Aires. Argentina
arellano@netverk.com.ar
Mensaje citado por Larry Glazerman <l.glazerman@rcn.com>:
> 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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