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Re: routine intrapartum labs From: Efrain Ramirez (eramirez@icepr.com) Sun May 28 09:11:47 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Charlie Chambers: "stump prof" Previous message: RModugno@aol.com: "Re: new case" In reply to: Geffrey Klein, MD: "Re: routine intrapartum labs" Next in thread: Geffrey Klein, MD: "Re: routine intrapartum labs" Reply: Geffrey Klein, MD: "Re: routine intrapartum labs" >paying any money for this information is too much. Not for me - we have 21 years to confirm that. >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 Strange - but in general a vigorous child with a low pH and low HCO3 --alert the pediatrician for neonatal sepsis -I could not find a fine article written a few years back looking into that issue. One issue about selecting the cord gases is your judgement on what constitutes a "normal" labor - what's a normal/abnormal FHR tracing, etc.- it varies a lot - from one MD to another - I'll send you a good review in "Clinical Obstetrics & Gynecology" >2) depressed 26 week infant with a cord pH of 7.35, BE -5 Normal finding and a good start for the baby. >Please give me an example of a case where the result of the cord gas >will change your clinical management.. You are missing the point Geff - it's not changing MY management - it's an objectice data of events around labor and delivery. >>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... Well if you don't see it - maybe I expressed myself wrongly -- >>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? I see a clinical benefit from it - as well as many others but I have come to realize that in some issues, to continue the argument will be useless - as always the best teacher there is -time - will tell. Good luck!! As for the placenta -- in good hands - I agree with Charlie. > >-- >_______________________ >Geffrey H. Klein, MD >_______________________ >geffrey.klein@obgyn.net >200 Medical Center Blvd Suite 103 >Webster, TX 77598 >(281) 332 6723 > >http://www.geffreyklein.com > -- "The things you learn after you know everything are the important ones" Next message: Charlie Chambers: "stump prof" Previous message: RModugno@aol.com: "Re: new case" In reply to: Geffrey Klein, MD: "Re: routine intrapartum labs" Next in thread: Geffrey Klein, MD: "Re: routine intrapartum labs" Reply: Geffrey Klein, MD: "Re: routine intrapartum labs"

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