Re: Clinical scenario
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Oct 9 20:08:14 2006
Exacto .. this lady was in labor.. protacted .. management is
augmentation..
Ef
>At Mon, 09 Oct 2006, Joe Cutchin wrote:
>
>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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