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Re: Clinical scenario From: Elrod, Darryl G Maj 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL) Thu Oct 12 02:36:03 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Clinical scenario" Previous message: DoctorJoe@aol.com: "Re: Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care" In reply to: Garry E. Siegel, M.D.: "Re: Clinical scenario" In fact, it was a fast labor. It was about 2 hours after amniotomy until delivery. Baby did fine and mom did fine. I guess my real point in bringing this up is more for what defines labor in the close to term patient. We've all seen women that were 3cm at 36 weeks and we did nothing about it, thinking they would declare themselves one way or another. But the thought that being 8cm wasn't declaring themselves made me wonder what would be? I appreciate the debate though. 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. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Sunday, October 08, 2006 7:41 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Clinical scenario Agree with all--let her sit in the hospital somewhere until she declares herself. If not obviously laboring, would consider oral PCN (and covert to IV once laboring) to cover GBS since her status is unknown and she is preterm. Garry At Sun, 8 Oct 2006, Myer Bornstein wrote: > >I agree with Efrain, no paint waiting should be a fast labor >Myer > >> -----Original Message----- >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain >> Ramirez >> Sent: Sunday, October 08, 2006 2:19 PM >> To: Multiple recipients of list OB-GYN-L >> Subject: Re: Clinical scenario >> >> Watch for the baby to fall out!! :) - she is in labor .. ampicillin 2 >> gms stat ,then 1 gm q 4 hours, AROM - no corticosteroids! good luck.. >> >> Ef >> >> >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 >> > >> >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. >> >> -- >> " The greatest obstacle to knowledge is not ignorance, >> it is the illusion of knowledge." Daniel J. Boorstin - Historian -- Garry E. Siegel, M.D. Private Practice Roswell, GA Next message: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Re: Clinical scenario" Previous message: DoctorJoe@aol.com: "Re: Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care" In reply to: Garry E. Siegel, M.D.: "Re: Clinical scenario"

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