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Re: Post dates pregnancy From: Richard Kaplan (rkaplan@triad.rr.com) Sat Mar 31 09:51:56 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Post dates pregnancy" Previous message: art fougner, md: "Re: Post dates pregnancy" Maybe in reply to: fbassani@brmc.com: "Post dates pregnancy" Next in thread: Andrew Folley: "Re: Post dates pregnancy" O.K. We have a term pregnancy with a normal BPP (was it 8/10 because the NST was not added in yet or because there was a problem with fetal breathing, tone, movement, or fluid volume?). We have a reactive NST following a few "late" decels (How were these determined? Was she contracting? Were they consistent?). I assume we have a baby with normal growth and a mother with no diabetes, hypertension, etc. We have a totally unfavorable situation for induction. If I were to consult my risk manager I would perform a cesarean. Otherwise I see no problem with repeating a BPP and NST in 3 days and see if vaginal delivery becomes an option. The question of not wanting the roof to collapse is a good one, but you could argue that any baby near or at term could have a bad outcome. Richard Kaplan Greensboro, NC >----- Original Message ----- From: fbassani@brmc.com To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> Sent: Saturday, March 31, 2007 10:28 AM Subject: Post dates pregnancy > Question: > > how would any of you manage the following case; > > A 23 yo Primagravida at 40 weeks and 3 days, with excellent 1st > trimester dating sonography, presents to the office complaining of > decreased fetal movement. > Cervical exam at that time is closed high, and unengaged, balottable, > yet vertex. > NST shows two late decelerations at first that respond to position > change. A vibroacustic stimulator is used and a reactive NST is > obtained. > BPP was 8/10 prior to reactive nst. > > My patient was sent home with continued expectant management, by a locum > physician. I contend that "hat are we waiting for?" We have a > primagravida with Post dates, questionable antenatal testing, decreased > fetal movement, unengaged head at term, and the need for vibroacustic > stimulation to obtain a reactive tracing. Does the roof need to fall in > on someone to tell them to get out? > I would love some comments and/or thoughts on this. > I am on vacation, and the patient is still pregnant! > Dr Bassani PA > Next message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Post dates pregnancy" Previous message: art fougner, md: "Re: Post dates pregnancy" Maybe in reply to: fbassani@brmc.com: "Post dates pregnancy" Next in thread: Andrew Folley: "Re: Post dates pregnancy"

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