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Re: Auscultation of the FH between spinal and incision in elective C/S From: Yankowitz, Jerome (jerome-yankowitz@uiowa.edu) Thu May 15 01:34:32 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: GIN11153@aol.com: "Medical Economics article on the best EHRs for small practices" Previous message: Raymond Stephen: "Re: Auscultation of the FH between spinal and incision in elective C/S" Maybe in reply to: John Robertson: "Auscultation of the FH between spinal and incision in elective C/S" Next in thread: Charles Bloom: "Re: Auscultation of the FH between spinal and incision in elective C/S" Has been an ongoing conversation here as well. Some of the answer may depend on where you are writing from but I personally suggest obtaining some fetal heart documentation. For a physician who does the c/s expeditiously it might be argued that there is no change in management. Often, however, delivery doesn't take place as fast as some might think unless you review a lot of situations and have all the timing available (time of spinal, incision, delivery, etc). Many on the list are from American facilities with trainees and who does the c/s and how fast may, in fact, change with additional information. While the delivery is "elective" administration of operative level anesthesia, with supine position (+/- different amounts of left tilt) can cause hypotension, decreased uterine perfusion and potentially a less than desireable tracing. For the c/s on a potentially compromised fetus this is all magnified. Just my opinion. ________________________________ From: ob-gyn-l@obgyn.net on behalf of Raymond Stephen -- ________________________________ Sent: Wed 5/14/2008 10:49 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Auscultation of the FH between spinal and incision in elective C/S Never do any investigation, the result of which is not going to change your management. How would knowing the status of the fetal heart change anything after the patient has had her spinal for a caesarean section? I have had some heated discussion with some individuals on this matter, and I think it is a crock! Steve Steve Raymond FRANZCOG FRCOG HOD Obstetrics & Gynaecology Royal Hobart Hospital Tasmania 7001 -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Meenan, Anna Sent: Thursday, 15 May 2008 12:47 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Auscultation of the FH between spinal and incision in elective C/S I don't know about the science, but the guy who does most of the c-secs on our service insists on this. Anna Meenan, MD >There is an effort by non-physicians in our hospital to introduce a >nursing practice guidline requiring the auscultation of the fetal heart >after administration of the spinal anaesthetic and prior to the skin >incision in all elective cesarean sections. I have questioned the logic >of this for several reasons, but rather than biasing the thread further, >I would be interested in what others think. I would be especially >interested in any science for or against this. John. > >-- >J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9 CONFIDENTIALITY NOTICE AND DISCLAIMER The 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. Next message: GIN11153@aol.com: "Medical Economics article on the best EHRs for small practices" Previous message: Raymond Stephen: "Re: Auscultation of the FH between spinal and incision in elective C/S" Maybe in reply to: John Robertson: "Auscultation of the FH between spinal and incision in elective C/S" Next in thread: Charles Bloom: "Re: Auscultation of the FH between spinal and incision in elective C/S"

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