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Re: Ob: What would you doFrom: Ronald Ainsworth (ainsron@sbcglobal.net)Wed Nov 8 23:56:38 2006
Observe in the hospital, start induction at 12 hours if not active. Discuss option of elective C/S for large baby, unfavorable cervix. If she wants a TOL, section if she falls off the curve once active. I disagree with those who critisized doing an exam. I always want to know my starting point. I had a patient yesteday who presented with a backache at 35wk 6d, she was having some uterine activity and the experienced OB nurse wasn't impressed and asked if she should check her before she sent her home. She had been a breech one day previously and we couldn't do a version because of a nuchal cord. Turns out she was complete with the BOW at +2. Ended up delivering her 30 minutes later as a vaginal breech. Turned out well, but I was a little rusty with the Pipers for the ACH. "Garry E. Siegel, M.D." <garrys@mindspring.com> wrote: 26 YO P0 at 39w4d, good dates, prsents with SROM for 4 hours, clear fluid, rare contractions. Due to a suspected fetal arrythmia, she had a Maternal-Fetal Scan 9 days ago. EFW 4438g, AFI 29. Her diabetes screen had been normal. The cardiac anatomy was normal and heart tones were regular with no evidence of any abnormality. The fundal height today was 43 cm., clinical EFW 4500g+. She had gross ROM, clear fluid, 1.5/25/posterior/-3/vertex. She is GBS negative. What's next? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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