Re: Auscultation of the FH between spinal and incision in elective C/S
From: R. Daniel Braun (rd.braun@gmail.com)
Fri May 16 09:55:50 2008
Notice the guidelines say it should CONTINUE until the abdomen is prepped.
i.e. during spinal or epidural placement.
Dan
On Fri, May 16, 2008 at 6:01 AM, Efrain Ramirez <eramirezt@coqui.net> wrote:
> 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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> --
> "I can accept failure, but I can't accept not trying." - Michael Jordan
>
--
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
