Re: let's play part 2 (see part one for full story)
From: art fougner, md (evsono@pipeline.com)
Fri Aug 25 16:38:50 2000
no worries - just my opinion - i could be wrong - let's see how this
plays out.
art
At Fri, 25 Aug 2000, Efrain Ramirez wrote:
>
>Art - I can't make adequate judgments on one tracing alone- IMHO - it's
>the whole clinical scenario - sure I have done C/S with such a tracing
>(must see it - variability sometimes differs from one observer to the
>other) - but other variables must be present - like prolonged PROM,
>decreased AF - decreased FM's etc. I believe that this patient should
>be allowed to have some rest - do a BPP and then act accordingly.
>
>At Fri, 25 Aug 2000, art fougner, md wrote:
>>
>>no abstract - sorry - however, very provocative and interesting reading.
>>
>> Br J Obstet Gynaecol 1982 Mar;89(3):179-85
>>
>>Categorization of terminal fetal heart-rate patterns in antepartum
>>cardiotocography.
>>
>>Langer O, Sonnendecker EW, Jacobson MJ
>>
>>the premise is that there is a trace ( quite similar to the one being
>>described) which justifies immediate delivery (apologies to Malcolm X)
>>by any means necessary.
>>
>>art
>>
>>At Fri, 25 Aug 2000, Efrain Ramirez wrote:
>>>
>>>I see no reason why this patient needs a C/S at this moment witout a
>>>BPP-IMHO - if BPP shows good FBM's - etc - 8/10 - negative OCT - if
>>>something happens to Mom - lot to explain -in my view - very well can
>>>have CNS/congenital anomalies - but you are saying that a non reactive
>>>NST (and a negative OCT)is a fetal indication for immediate C/S even if
>>>a BPP gives 8/10?
>>>
>>>At Fri, 25 Aug 2000, art fougner, md wrote:
>>>>
>>>>SECTION!
>>>>
>>>>art
>>>>
>>>>At Fri, 25 Aug 2000, K Dew wrote:
>>>>>
>>>>>to add more info.
>>>>>
>>>>>LTV 5-10 beat at most, STV was minimal.
>>>>>
>>>>>As mentioned, AFV normal. Biophysical profile not performed as OCT
>>>>>(extended: remember 8 hours of ctx without decels) AFV 48 hours prior was
>>>>>normal and mom cont'd to mention fetal movement as normal
>>>>>
>>>>>I decided to turn off the pitocin, feed the patient, let her shower and give
>>>>>her misoprostol 25 mg po at 2300,& 0300 and resume the pitocin at 0700 the
>>>>>following morning.
>>>>>
>>>>>still decreased ltv and stv, no decels
>>>>>
>>>>>cx still at 80%, FT, -3
>>>>>
>>>>>comments please, more info to follow
>>>>>
>>>>>Kevin
>>>>
>>>>--
>>>>art fougner, md
>>>>
>>>>A series of 1000 cases begins with but a single anecdote.
>>>>
>>>--
>>>"Do not take life too seriously. You will never get out of it alive."
>>>
>>>Marianne Williamson
>>>
>>--
>>art fougner, md
>>
>>A series of 1000 cases begins with but a single anecdote.
>>
>--
>"Do not take life too seriously. You will never get out of it alive."
>
>Marianne Williamson
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
