Re: What would you do
From: Dr. NaseemAhmad (dr_naseemahmad@yahoo.com)
Thu Nov 9 21:47:59 2006
you may be right but adequate monitoring entails comprehending the
properly maintained Partogram. Active management should ensure
initiation of proper labour and if the head doesnt descend or cervix
doesnt dilate despite proper contractions over the next 4 to 6 hours I
would certainly do c/s.Caesarean too has a certain degree of morbidity,
doesn't it?
Naseem ahmad
At Thu, 9 Nov 2006, R. Daniel Braun wrote:
>
>Over my 42 years of practice, I have seen an awful lot of those that did not
>end up so happily. Mother cleaning and dressing infected wound for 3 weeks
>while it heals isn't a good outcome in my opinion. That is what happens when
>you let these ladies laobr or be pitted for 24-48 hours and then end up
>doing a section.
>35 years ago when the section rate overall was less than 8%, if a P0G1
>presented with an unengaged head, the section rate was near 50% and most of
>those were pitted for a long time before the section was done.
>
>Dan
>
>On 11/9/06, Dr. NaseemAhmad <dr_naseemahmad@yahoo.com> wrote:
>>
>> During my training as Registrar I was taught exactly what Dan is
>> suggesting but over the years having managed hundreds of such cases my
>> belief is that majority of such cases happily end up having an
>> uneventful normal delivery albeit close monitoring is mandatory. Hence
>> my approach will be to induce no matter what time of night or day it is
>> and dont hesitate to start an appropriate antibiotic
>>
>> Naseem Ahmad MD FRCOG
>>
>> At Thu, 9 Nov 2006, R. Daniel Braun wrote:
>> >
>> >P0G1 at term, EFW 10# (almost, only 102 Gm shy), unengaged head, Un ripe
>> >cervix, with SROM. What is the question????? Section her
>> >NOW!!!!!!!!!!!!!!!!!!!!!!!
>> >
>> >Dan
>> >
>> >On 11/8/06, Jane Peterson <ApricotRex@comcast.net> wrote:
>> >>
>> >> Send her home with the usual prohibitions. Plan an induction for 18
>> >> hours post SROM if she doesn't arrive in labor before then.
>> >>
>> >> (Caveat: I wouldn't have VE'd her until she was having contractions or
>> >> we were starting an induction)
>> >>
>> >> -----Original Message-----
>> >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
>> >> E. Siegel, M.D.
>> >> Sent: Wednesday, November 08, 2006 5:57 PM
>> >> To: Multiple recipients of list OB-GYN-L
>> >> Subject: Ob: What would you do
>> >>
>> >> 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
>> >>
>> >--
>> >R. Daniel Braun
>> >
>> > "The way to health is an aromatic bath and scented massage
>> everyday".
>> > Hippocrates
>> >
>>
>--
>R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage everyday".
> Hippocrates
>
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