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Re: Intermittent auscultation From: Richard B. Kates, MD (rkates@arias.net) Wed Feb 17 16:24:59 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: John Robertson M.D.: "Re: Depo and menopause" Previous message: Betsy Hyde: "Intermittent auscultation" Maybe in reply to: Betsy Hyde: "Intermittent auscultation" Next in thread: Braun, R. Daniel: "Re: Intermittent auscultation" Look at the meta-analysis in the Gray Journal...'97 or '98, I believe, by Vintzileos, A. EFM reduces risk of death, and though not particularly studied, the risk of injury. RCTs of EFM vs IA are severely flawed, and have been refuted many times over. I am aware of the MD's in Wisconsin who promulgate this, and believe their patient population to be skewed. Am also aware of the college position, but the members wo promulgate IA all use EFM. Richard B. Kates, MD Perinatology Spokane, WA -----Original Message----- From: Betsy Hyde <elishyde@connix.com> To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net> Date: Wednesday, February 17, 1999 3:40 PM Subject: Intermittent auscultation >Our hospital, as part of its cesarean reduction program, has embraced >intermittent auscultation as a method of monitoring the fetus. The impetus >for IA is being led by an MD-RN committee. The ACOG Guidelines are >available, and there seems to be no patient who is too high risk for IA >with the possible exception of VBACs. > >While I am certainly not a proponent of continuous EFM, I do have some >issues with IA as it is being implemented, and wish to see what other list >members are doing. > >One concern involves documentation of fetal heart rate periodic changes. >The nurses have just been instructed to listen for 30 seconds during and >after a contraction and chart the number of beats during that time period. >For instance 70/30. There is no mention of audible accels or decels. When I >asked "why?" I was told "It doesn't matter". This is of concern to me, but >I was told that LTV/reactivity in labor "means nothing" and is not helpful >in predicting outcome. > >The second concern is that the emphasis is *no* use of the EFM at all. I >was always taught that documenting LTV/reactivity on admission was a good >thing to do, and, conversely, if a fetus enters labor with a pencil flat >tracing, it's good to have documented that, too. I believe this is one of >Jeff Phelan's beliefs, and it does make a certain amount of sense to me. >Again, I was told "it doesn't matter." > >The source of this information is an OB from Greenbay, WI (sorry, I forget >his name) who, according to the nurses, says that *any* snippets of tracing >just increase your liability. > >Although not a proponent of continuous EFM, neither am I a nihilist and I >have some concerns about the way this has been implemented, and its "all or >nothing" approach. > >Comments? > >Betsy Hyde CNM > Next message: John Robertson M.D.: "Re: Depo and menopause" Previous message: Betsy Hyde: "Intermittent auscultation" Maybe in reply to: Betsy Hyde: "Intermittent auscultation" Next in thread: Braun, R. Daniel: "Re: Intermittent auscultation"

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