Re: Clinical scenario
From: Elrod, Darryl G Maj 48 MDOS/SGOBO (Darryl.elrod@LAKENHEATH.AF.MIL)
Thu Oct 12 02:36:22 2006
She wanted to be delivered when she was 4-5.
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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-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Jamie
Sent: Sunday, October 08, 2006 8:41 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Clinical scenario
What does she want?
At Sun, 8 Oct 2006, Garry E. Siegel, M.D. wrote:
>
>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
>
--
JFields, RN, BSN
