Re: Feedback on Case
From: art fougner, md (evsono@pipeline.com)
Tue Jul 25 07:45:03 2000
let me get this straight - you observe a pattern thought to be
indicative of cord compression at term and you propose to send the
patient home undelivered?
art
At Mon, 24 Jul 2000, Jomyrwhipt@aol.com wrote:
>
>I was seeing a 30 y/o G5P1031 here at 39 weeks with uterine contractions q 5 minutes membranes intact. She was here for labor evaluation, nl fetal movement, no bleeding, ob hx of renal stones otherwise uncomplicated pregnancy course had a previous C/S for fetal intolerance to labor progressed to 9 cm. Pt was put on the monitor for fetal evaluation and had occasional variable decelerations, mild with late component but with excellent beat to beat and long term variability, otherwise reassuring tracing contracting irregularly every 3-5 minutes. The cervix exam was closed, 50%, -4, medium, posterior and of note - pt had a very narrow outlet. Pt was rechecked after 3 hours with no change. The patient was evaluated for > 3 hours and then was sent to Fetal Assessment for BPP which was 8/8. At this point, the case was reviewed by the obstetrician on duty, who felt the patient should be admitted for observation. My question is...would variables with late components with great v!
>ariability, long term and short term with BPP of 8/8, cause you to keep the patient and plan for delivery?
>
>The course: The patient decided to refuse a trial of labor and have a C/S. She had eaten 10 minutes prior to the decision to keep her, as her husband brought in lasagna...so, she had to wait 8 hours before having her C/S. The monitor continued to have occasional variables with an otherwise very normal tracing with reactivity. The patient is going in for C/S now and I believe the baby will be fine. However, I was just curious if you would have kept the patient with the above situation?
>
>Appreciate the input.
>
>Todd Miller, MD
>Maternity Care Coordinator
>Columbia University Family Medicine
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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