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Re: Auscultation of the FH between spinal and incision in elective C/SFrom: John Robertson (johngmrobertson@shaw.ca)Fri May 16 15:29:50 2008
At Fri, 16 May 2008, R. Daniel Braun wrote: > >Notice the guidelines say it should CONTINUE until the abdomen is prepped. >i.e. during spinal or epidural placement. > >Dan > I would actually say - notice the guidelines say it should CONTINUE until the abdomen is prepped i.e. we were monitoring this lady in labour and she had to go to C/S and we CONTINUED to monitor her, because we don't generally do continuous monitoring of women not in labour. The distinction is obvious and it is important. Certainly all patients arriving for their booked C/S should be assessed and the FH auscultated as part of the admission - that could certainly change the timing of the C/S. If however you listen after the spinal is in (and more than likely delay the person prepping the abdomen), how much time do you gain when you factor in the delay you've created. Also - do we actually know what is normal and what is abnormal for the FH right after the administration of the spinal? Are there acute changes that are acutely reversable, and have no long term effect? Are we more likely to call a normal FH abnormal, than the reverse? By converting an elective procedure in to an emergency one, how much do we increase the patient's risks, and are these risks outweighed by the actual benefits we would see? Just some of my thoughts - again, I would be quite interested in the science behind the decisions. Especially as we know that great idea called electronic fetal heart rate monitoring that was going to make things so much better actually didn't when we really studied it.
-- 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
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