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Re: Elective inductions at 38 weeksFrom: Andrew Folley (agfolley@hotmail.com)Tue Oct 9 12:02:39 2007
Gordon I sit on the OB quality committee at a level 3 hospital in Toledo. We are in the midst of discussions about a policy for "elective inductions". The majority of the OBs on staff favor a policy of elective inductions after 38 weeks and 0 days. I am the lone dissenting vote arguing for elective inductions ONLY after 39 weeks and 0 days. Any input from your experiece in ACOG. Other listers input would be very helpful as to what their hospital elective induction polices are as well. a thanks andy Date: Mon, 8 Oct 2007 20:49:17 -0500From: obgyndoc@swbell.netTo: ob-gyn-l@dns.obgyn.netSubject: Re: 'There is no gold standard for decision-to-incision time' ???Why wait for epidural dose? Why not 'crash' and intubate? Why scrub? 10 seconds could be the difference. Having been a 'battlefield surgeon' in a past life, I have a different perspective. If you have a heartbeat, run like hell and anesthesia be damned. I have had the unfortunate experience of having had to do some cases with succinyl (sp?) choline alone. She will get over the pain, the baby may not. Gordon M. Goldman, M.D., FACOG Private Practice, St. Louis, Mo. On Oct 8, 2007, at 8:04 PM, Andrew Folley wrote: Let me get this straight. We are racing back for an emergency stat C-section due to non reassuring tracing with an internal electrode. Baby having severe variables past 20 minutes and thenbaby just started a prolonged deceleration heading downwards from 100 to 90 to 80 etc. Decison made for stat c-section. Clock is running.We get back in the OR and hook up the monitor and the heart rate is 50s and steady. She gets her epidural dosed and is being prepped and the doctor does a 10 second "scrub". the internal is in place and suddenly drops to zero. The baby may very well indeed be dead.Who is in favor of froglegging her and inserting another electrode just in case the first one is not picking up? Who on the list is in favor of having one of the nurses listen for the heart rate with a doppler on the abdomen? Who opts for a quick US scan?? Or who says "Give me the scapel and get out of my way and I will have a baby dead or alive for you in less than 60 seconds?????? Sign me up for the latter option,.Respectfully yours Dr. Bard A. Parker Date: Mon, 8 Oct 2007 04:23:30 -0500From: rd.braun@gmail.comTo: ob-gyn-l@dns.obgyn.netSubject: Re: 'There is no gold standard for decision-to-incision time' ???Nor would I, but it wiuld probably be the right thing.Dan On 10/7/07, Raymond Stephen <stephen.raymond@dhhs.tas.gov.au > wrote: In my view, there is rarely an indication to section for a dead baby, BUT informing a mother on the table that her baby is dead and you are not going to proceed with the Caesar after all, is not a situation I would relish! Steve From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] On Behalf Of R. Daniel BraunSent: Monday, 8 October 2007 10:39 AM To: Multiple recipients of list OB-GYN-LSubject: Re: 'There is no gold standard for decision-to-incision time' ??? If your indication for the section is fetal distress, certainly. You no longer have that indication. Or do you section people for a dead baby?Dan On 10/7/07, Raymond Stephen < stephen.raymond@dhhs.tas.gov.au> wrote: So if you find there are no fetal heart sounds as the last person arrives, what do you do then? Stand down the team and allow to deliver vaginally? Steve From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] On Behalf Of R. Daniel BraunSent: Sunday, 7 October 2007 12:11 PMTo: Multiple recipients of list OB-GYN-LSubject: Re: 'There is no gold standard for decision-to-incision time' ??? Question relating to the case presented. How long from last listening for FHT's and incision? It is easy to stand around in the OR waiting for that last member of the team to arrive and then just make the incision when they get there. One should always know whether or not there is a heart beat before making the incision. IMHO. With a one and 5 minute apgar of "0", I find it hard to believe that there were ht. tones present in the last 3-5 minutes befor the incision.Dan On 10/6/07, Efrain Ramirez <eramirezt@coqui.net> wrote: There is no gold standard for decision-to-incision timeDon't accommodate plaintiff's attorneys who have reinvented an intendedguideline as a requirement!CONFIDENTIALITY NOTICE AND DISCLAIMERThe information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose. -- R. Daniel Braun, MD FACOG(L) CMTProfessor EmeritusDept. of Obstetrics and GynecologyIndiana U. School of MedicineR. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 CONFIDENTIALITY NOTICE AND DISCLAIMERThe information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose.-- R. Daniel Braun, MD FACOG(L) CMTProfessor EmeritusDept. of Obstetrics and GynecologyIndiana U. School of MedicineR. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 Peek-a-boo FREE Tricks & Treats for You! Get 'em! _________________________________________________________________ Peek-a-boo FREE Tricks & Treats for You! _________________________________________________________________ http://www.reallivemoms.com?ocid=TXT_TAGHM&loc=us
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