Re: Elective inductions at 38 weeks
From: FRANCES WREN (fwren@shaw.ca)
Tue Oct 9 12:45:39 2007
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agree ..elective inductions only after 39 weeks...unless good reason why needs to be earlier.
frances wren MD FRCS
>----- Original Message -----
From: Andrew Folley <agfolley@hotmail.com>
Date: Tuesday, October 9, 2007 10:07 am
Subject: Re: Elective inductions at 38 weeks
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>
> 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!
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<DIV>agree ..elective inductions only after 39 weeks...unless good reason why needs to be earlier.</DIV>
><DIV>frances wren MD FRCS<BR><BR>----- Original Message -----<BR>From: Andrew Folley <agfolley@hotmail.com><BR>Date: Tuesday, October 9, 2007 10:07 am<BR>Subject: RE: Elective inductions at 38 weeks<BR>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net><BR><BR>> <BR>> Gordon<BR>> I sit on the OB quality committee at a level 3 hospital in <BR>> Toledo. We are in the midst of discussions about a policy <BR>> for "elective inductions". The majority of the OBs on <BR>> staff favor a policy of elective inductions after 38 weeks and 0 <BR>> days. I am the lone dissenting vote arguing for elective <BR>> inductions ONLY after 39 weeks and 0 days. Any input <BR>> from your experiece in ACOG. Other listers input would be <BR>> very helpful as to what their hospital elective induction <BR>> polices are as well. a thanks andy<BR>> <BR>> <BR>> Date: Mon, 8 Oct 2007 20:49:17 -0500From: obgyndoc@swbell.netTo: <BR>> ob-gyn-l@dns.obgyn.netSubject: Re: 'There is no gold standard <BR>> for decision-to-incision time' ???Why wait for epidural <BR>> dose? Why not 'crash' and intubate? Why scrub?&n
bsp; <BR>> 10 seconds could be the difference. <BR>> <BR>> Having been a 'battlefield surgeon' in a past life, I have a <BR>> different perspective. If you have a heartbeat, run like <BR>> hell and anesthesia be damned. I have had the unfortunate <BR>> experience of having had to do some cases with succinyl (sp?) <BR>> choline alone. She will get over the pain, the baby may <BR>> not. <BR>> <BR>> Gordon M. Goldman, M.D., FACOG<BR>> <BR>> Private Practice, St. Louis, Mo.<BR>> <BR>> On Oct 8, 2007, at 8:04 PM, Andrew Folley wrote:<BR>> Let me get this straight. We are racing back for an <BR>> emergency stat C-section due to non reassuring tracing with an <BR>> internal electrode. Baby having severe variables past 20 minutes <BR>> and thenbaby just started a prolonged deceleration heading <BR>> downwards from 100 to 90 to 80 etc. Decison made for stat <BR>> c-section. Clock is running.We get back in the OR and hook <BR>> up the monitor and the heart rate is 50s and steady. She <BR>> gets her epidural dosed and is being prepped and the doctor does <BR>> a 10 second "scrub". the internal is in place and suddenly <BR>> drops to zero
. The baby may very well indeed be dead.Who <BR>> is in favor of froglegging her and inserting another electrode <BR>> just in case the first one is not picking up? Who on the list is <BR>> in favor of having one of the nurses listen for the heart rate <BR>> with a doppler on the abdomen? Who opts for a quick US <BR>> scan?? Or who says "Give me the scapel and get out of my <BR>> way and I will have a baby dead or alive for you in less than 60 <BR>> seconds?????? Sign me up for the latter <BR>> option,.Respectfully yours Dr. Bard A. Parker<BR>> <BR>> <BR>> Date: Mon, 8 Oct 2007 04:23:30 -0500From: rd.braun@gmail.comTo: <BR>> ob-gyn-l@dns.obgyn.netSubject: Re: 'There is no gold standard <BR>> for decision-to-incision time' ???Nor would I, but it wiuld <BR>> probably be the right thing.Dan<BR>> On 10/7/07, Raymond Stephen <stephen.raymond@dhhs.tas.gov.au <BR>> > wrote: <BR>> <BR>> <BR>> In my view, there is rarely an indication to section for a dead <BR>> baby, BUT informing a mother on the table that her baby is dead <BR>> and you are not going to proceed with the Caesar after all, is <BR>> not a situation I would relish! Steve <BR>
8;gt; <BR>> <BR>> <BR>> From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] On Behalf <BR>> Of R. Daniel BraunSent: Monday, 8 October 2007 10:39 AM <BR>> To: Multiple recipients of list OB-GYN-LSubject: Re: 'There is <BR>> no gold standard for decision-to-incision time' ???<BR>> <BR>> If your indication for the section is fetal distress, certainly. <BR>> You no longer have that indication. Or do you section people for <BR>> a dead baby?Dan<BR>> On 10/7/07, Raymond Stephen < <BR>> stephen.raymond@dhhs.tas.gov.au> wrote:<BR>> <BR>> So if you find there are no fetal heart sounds as the last <BR>> person arrives, what do you do then? Stand down the team <BR>> and allow to deliver vaginally? Steve <BR>> <BR>> <BR>> <BR>> From: ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] On Behalf <BR>> Of R. Daniel BraunSent: Sunday, 7 October 2007 12:11 PMTo: <BR>> Multiple recipients of list OB-GYN-LSubject: Re: 'There is no <BR>> gold standard for decision-to-incision time' ??? Question <BR>> relating to the case presented. How long from last listening for <BR>> FHT's and incis
ion? It is easy to stand around in the OR waiting <BR>> for that last member of the team to arrive and then just make <BR>> the incision when they get there. One should always know whether <BR>> or not there is a heart beat before making the incision. <BR>> IMHO. With a one and 5 minute apgar of "0", I find it hard to <BR>> believe that there were ht. tones present in the last 3-5 <BR>> minutes befor the incision.Dan<BR>> On 10/6/07, Efrain Ramirez <eramirezt@coqui.net> wrote:<BR>> There is no gold standard for decision-to-incision timeDon't <BR>> accommodate plaintiff's attorneys who have reinvented an <BR>> intendedguideline as a requirement!CONFIDENTIALITY NOTICE AND <BR>> DISCLAIMERThe information in this transmission may be <BR>> confidential and/or protected by legal professional privilege, <BR>> and is intended only for the person or persons to whom it is <BR>> addressed. If you are not such a person, you are warned that any <BR>> disclosure, copying or dissemination of the information is <BR>> unauthorised. If you have received the transmission in error, <BR>> please immediately contact this office by telephone, fax or <BR>> email, to inform us of the error and to enable arrangements to <BR>> be made for the destruction of the transmission, or its return <BR>> at our cost. No liability is accepted for any unauthorised use <BR>&
gt; of the information contained in this transmission. If the <BR>> transmission contains advice, the advice is based on <BR>> instructions in relation to, and is provided to the addressee in <BR>> connection with, the matter mentioned above. Responsibility is <BR>> not accepted for reliance upon it by any other person or for any <BR>> other purpose. -- R. Daniel Braun, MD FACOG(L) <BR>> CMTProfessor EmeritusDept. of Obstetrics and GynecologyIndiana <BR>> U. School of MedicineR. Daniel <BR>> Braun "Science without <BR>> Religion is LAME; Religion without Science is <BR>> BLIND" Einstein 1941 <BR>> CONFIDENTIALITY NOTICE AND DISCLAIMERThe information in this <BR>> transmission may be confidential and/or protected by legal <BR>> professional privilege, and is intended only for the person or <BR>> persons to whom it is addressed. If you are not such a person, <BR>> you are warned that any disclosure, copying or dissemination of <BR>> the information is unauthorised. If you have received the <BR>&#
038;gt; transmission in error, please immediately contact this office by <BR>> telephone, fax or email, to inform us of the error and to enable <BR>> arrangements to be made for the destruction of the transmission, <BR>> or its return at our cost. No liability is accepted for any <BR>> unauthorised use of the information contained in this <BR>> transmission. If the transmission contains advice, the advice is <BR>> based on instructions in relation to, and is provided to the <BR>> addressee in connection with, the matter mentioned above. <BR>> Responsibility is not accepted for reliance upon it by any other <BR>> person or for any other purpose.-- R. Daniel Braun, MD <BR>> FACOG(L) CMTProfessor EmeritusDept. of Obstetrics and <BR>> GynecologyIndiana U. School of MedicineR. Daniel <BR>> Braun "Science without <BR>> Religion is LAME; Religion without Science is <BR>> BLIND" Einstein 1941<BR>> <BR>> Peek-a-boo FREE Tricks & Treats for You! Get 'em!<BR>> __&
#095;______________________________________________________________<BR>> Peek-a-boo FREE Tricks & Treats for You!<BR>> http://http://www.reallivemoms.com?ocid=TXT_TAGHM&loc=us</DIV>
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