Re: routine intrapartum labs
From: Jim Connerth (babydoc@apex.net)
Sat May 27 18:11:33 2000
"Geffrey Klein, MD" wrote:
> 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?
> More data for the "experts" & lawyers to debate over-and try and make you
> look stupid!!!
> --
> _______________________
> Geffrey H. Klein, MD
> _______________________
> geffrey.klein@obgyn.net
> 200 Medical Center Blvd Suite 103
> Webster, TX 77598
> (281) 332 6723
>
> http://www.geffreyklein.com
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