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Re: routine intrapartum labs From: Geffrey Klein, MD (gklein@icsi.net) Sat May 27 17:56:27 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Jim Connerth: "Re: routine intrapartum labs" Previous message: Efrain Ramirez: "Re: routine intrapartum labs" In reply to: Efrain Ramirez: "Re: routine intrapartum labs" Next in thread: Geffrey Klein, MD: "Re: routine intrapartum labs ---> placenta pathology" Reply: Geffrey Klein, MD: "Re: routine intrapartum labs ---> placenta pathology" Reply: Efrain Ramirez: "Re: routine intrapartum labs" At 3:17 PM -0500 on 5/27/00, Efrain Ramirez wrote: > >IMHO-you are wrong--it is not defensive medicine - at least the way I >see it. I do my best to do just good medicine -- not defensive >medicine. To me it is an objective data of the fetus's condition - as >with BP, temperature (besides touching a patient and asking her how she >feels you must get some data don't you??) . >We do pH and if below 7.15 or so - then the whole thing - about 20 bucks >- too much? paying any money for this information is too much. Ok.. I will ask you then, how does knowing the cord gas alter your management in the following cases... 1) vigorous term infant with apgars 9,9 and a cord pH of 6.95, BE -15 2) depressed 26 week infant with a cord pH of 7.35, BE -5 Please give me an example of a case where the result of the cord gas will change your clinical management.. >ACOG has changed its mind so many times - we all do!! - remember herpes >cultures - how about VBAC's ?? Do you do now early repair of 4th degree >dehiscence - years ago it was heresy- - ACOG is not the Pope - >My belief is that in the future, cord gases will become a standard of >care - as with the APGAR score - to quantify your clinical impression - >before the apgar scores - the baby was Ok - or a bit depressed -- right? >You must at least admit that it is not a stupid idea and there are >articles out there supporting such approach. ok... where? What exactly is the point? I don't see any rationale... >Your conclusions are too dogmatic -in my opinion. But as Wooley would say, the default is not doing something unless there is some clinical benefit. So, as a patient, please convince me why I should pay the hospital for a cord gas. IOW, what I am getting for my money? -- _______________________ Geffrey H. Klein, MD _______________________ geffrey.klein@obgyn.net 200 Medical Center Blvd Suite 103 Webster, TX 77598 (281) 332 6723 http://www.geffreyklein.com Next message: Jim Connerth: "Re: routine intrapartum labs" Previous message: Efrain Ramirez: "Re: routine intrapartum labs" In reply to: Efrain Ramirez: "Re: routine intrapartum labs" Next in thread: Geffrey Klein, MD: "Re: routine intrapartum labs ---> placenta pathology" Reply: Geffrey Klein, MD: "Re: routine intrapartum labs ---> placenta pathology" Reply: Efrain Ramirez: "Re: routine intrapartum labs"

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