Re: Auscultation of the FH between spinal and incision in elective C/S
From: Efrain Ramirez (eramirezt@coqui.net)
Fri May 16 05:00:18 2008
We always do an NST prior elective C/S - saw a patient Friday - perfect
everything.. early Monday morning she presented with severe - I mean
long profound decelerations ... C/S was obviously done at a much faster
pace.. APGAR 7/8 with a pH 7.0 something.. found nothing unusual.. one
wonders.
>From ACOG's Guidelines for Perinatal Medicine
In women requiring cesarean delivery, fetal surveillance should continue
until abdominal sterile preparation has begun. If internal fetal heart
rate monitoring is in use, it should be continued until the abdominal
sterile preparation is complete. Consideration should be given to the
use of antiembolic elastic stockings or pneumatic compression boots in
women considered at high risk for venous thromboembolism. When the
cesarean delivery is performed for fetal indications, consideration
should be given to sending the placenta for pathologic evaluation.
Ef
At Fri, 16 May 2008, Raymond Stephen wrote:
>
>I would be interested to hear of an example of a case where the
>monitoring led to your doing something different from what had been
>planned.
>
>Steve
>
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R.
>Daniel Braun
>Sent: Thursday, 15 May 2008 9:14 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Auscultation of the FH between spinal and incision in
>elective C/S
>
>When I was still practicing, I insisted on continuing to monitor the FHR
>during and after spinal placement. These are the times that it may be
>most beneficial to monitor.
>
>Dan
>
>On Thu, May 15, 2008 at 6:45 AM, Charles Bloom <cdsb@bellsouth.net>
>wrote:
>
>We monitor the FHR only if there is going to be a delay. If you proceed
>immediately with Cesarean, any attempt to monitor the FHR delays
>delivery.
>Write your policy accordingly.
>
>Charles
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of John
>Robertson
>Sent: Wednesday, May 14, 2008 10:11 PM
>To: Multiple recipients of list OB-GYN-L
>
>Subject: Auscultation of the FH between spinal and incision in elective
>C/S
>
>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
>
>(604) 793-9988 e-mail john.robertson@obgyn.net
>Who is wise and understanding among you? Let him show it by his good
>life,
>by deeds done in the humility that comes from wisdom. James 3 vs 13,
>NIV
>
>--
>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
>
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