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"routine" prenatal visit LONG of courseFrom: K Dew (kdew@bellsouth.net)Sat Aug 19 07:37:02 2000
Comments in the thread about bed rest make me want to poll the list about what they consider part of the routine prenatal visit. I always get weight, dip the urine, bp (left side), fundal height, fetal heart tones by Doppler, check for edema. depending on the answers to the questions "are you having cramps/contractions/unusual discharge/bleeding/pressure I may do a spec exam/wet mount/cervical exam. I do not start "regular" cervical exams until 40 weeks unless the screening questions are positive. My reasoning is a) they are uncomfortable and b)I've found that, in the absence of symptoms I've rarely had a cervical exam finding change my management. I've found that the head well applied to the cervix at a -1 station to become well out of the pelvis with bed rest on labor and delivery. I've found the closed cervix with the ballotable head to be 4 cm and +1 within an hour or two of leaving the office. A couple of months ago there were some comments about patient management based on knowing "what the last cervical check was" I thought this was a pretty silly approach as, in the absence of labor, what you see/feel today is not necessarily influential on the exam tomorrow or reflective of the exam you had last week. And, evidence based or not, I have quite a few patients on bed rest. I do it when there a patients who are pre-term, symptomatic, dilated or effaced and with a head well applied to the cervix. I ain't no genius but it seems that if we tell patients that "false labor goes away with walking, real labor doesn't" and if we remember the forces of gravity that limiting activity and changing gravity's effect from an upright baby on a cervix to a sideways pressure on the uterus (i.e. lying down) we might, just might, have a positive influence. And another btw, the last ACOG update tape on multiple pregnancy management does mention that bed rest has a positive effect on multiple gestation and pre-term delivery. I'm really done now just my $.02 Kevin Dew ob/gyn Bardstown, KY
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