Re: "routine" prenatal visit LONG of course

From: Larry Glazerman (l.glazerman@rcn.com)
Sat Aug 19 08:12:00 2000

I start cervical checks at 36-37 weeks, partly because most of my patients expect them, due to community practices. I've had several patients who don't want them done, and that's fine with me.

Also, at the risk of being crucified here, since I'm in solo practice, I do a fair number of elective inductions, after 39 weeks, and the cervical checks help out there. I won't electively induce someone who isn't ripe.

At 07:38 AM 8/19/00 -0500, you wrote: >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

--
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown
610-402-0161
l.glazerman@rcn.com



use when must restrict search to only the ob-gyn-l forum...
Enter search keywords:
Returns per screen: Require all keywords:

Return to OB-GYN-L Mail a New Message to the Forum: ob-gyn-l@obgyn.net
Forum Administrator: geffrey.klein@obgyn.net
Report Technical Problems: webmaster@obgyn.net
Last Updated: Mon Nov 2 04:45:19 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.

Women's Insurance Checklist from Auto Insurance Quote

home | medical professionals | women | industry | forums | international
e-mail | about us | advertising | our sponsors | contact us | disclaimer |

This information is provided for educational purposes only.
Please read the disclaimer. ©1996-2008, all rights reserved.
Do not reproduce without permission of MediSpecialty.com