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Re: Today was a GOOD day! From: Meenan, Anna (annam@uic.edu) Fri Feb 29 12:39:24 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: westsidebirthservice@juno.com: "Re: Today was a GOOD day!" Previous message: ainsron: "Re: Today was a GOOD day!" In reply to: R. Daniel Braun: "Re: Today was a GOOD day!" Next in thread: Dr Eberhard Lisse: "Re: Today was a GOOD day!" Reply: Dr Eberhard Lisse: "Re: Today was a GOOD day!" Well, in our hospital, we don't always have a ped around, but I'm not real big on breaking the bag just to see if there is mec either, since i am NRP certified. Our nurses are real big on it, however, and the NICU crew complains if they get called at the last minute, even though they are right down the hall. OTOH, I'm not into having moms push with bag intact if it's bulging way out ahead of the baby, as eventually the resident standing in front of mom's perineum will get soaked, so if there is a big bulgy bag and it is time to push, I usually do break it. In this case, there actually was thin mec, but heart tones had excellent variability when the spiral was placed. I suspect the deep variables with ctx were a combination of nuchal cord X1 and rapid descent. I'm actually not particularly interested in what the Board would say, because if this girl was me, I would have expected my birth attendant to do exactly the same thing. Oh, BTW, apgars were 9/9. Anna Meenan, MD >Anna, >I was not being facetious. However, you just gave a good reason to >break the BOW.(To adequately monitor the fetus) You didn't tell us >that before. (or I missed it) >John, >Breaking the bag because you think there might be meconium is one of >those indications that people accept, but there is not much evidence >for it. What difference does it make in your management ??? Perhaps >in smaller hospitals without Peds present down the hall, it might >make you call in the peds if you knew it was present.(that would >justify it). In our hospital where we have peds residents and >neonatal fellows 20 yards away, it really doesn't. > >Dan > >On Fri, Feb 29, 2008 at 12:04 PM, Dr. John Provatopoulos B.Sc. >M.D.C.M. F.R.S.C. ><<mailto:johnprov@sympatico.ca>johnprov@sympatico.ca> wrote: > >At Fri, 29 Feb 2008, R. Daniel Braun wrote: >> >>And why did you break the BOW??? You already had decels earlier and now you >>take away the baby's protective mechanism???? >> >>Yes I know everyone FEELS that breaking the bag helps things along. BUT ALL >>of the STUDIES show that it does NOT!!!!!! >> >>Dan >> > >Dan I don't see anything wrong with an arm at 9cm, I would do it to >check for thick mec more than anything, thick mec deccels and decreaces >variablity would make me call in the Pediatrician from home. > >-- > Take care, John > >-- >R. Daniel Braun, MD FACOG(L) ABMP CMTh >Professor Emeritus >Dept. of Obstetrics and Gynecology >Indiana U. School of Medicine > >R. Daniel Braun > > "Science without Religion is LAME; Religion without Science is BLIND" > Einstein 1941 Next message: westsidebirthservice@juno.com: "Re: Today was a GOOD day!" Previous message: ainsron: "Re: Today was a GOOD day!" In reply to: R. Daniel Braun: "Re: Today was a GOOD day!" Next in thread: Dr Eberhard Lisse: "Re: Today was a GOOD day!" Reply: Dr Eberhard Lisse: "Re: Today was a GOOD day!"

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