OB-GYN-L Messages for November, 2000: Re: OB: What is a late deceleration? (case and discussion--long)

Re: OB: What is a late deceleration? (case and discussion--long)

From: Luis Sanchez-Ramos, MD

luis.sanchez@jax.ufl.edu

Tue Nov 28 06:02:34 2000

Is there any way that you could post the more characteristic portions of the strip? There is no way to tell from your description whether these were late or variable decelerations. NIH group came out with revised definitions which no one has paid much attention to. Don't get carried away, pulse oxymetry will not replace EFM; it may reduce the number of paltients who require scalp pH sampling. By the way, in a case like yours, if unsure, I perform scalp pH sampling. Yes, I know, it is hardly done in private practice. Also, there are many who claim that scalp sampling is not necessary if one "knows how to interpret EFM strips" properly. Most of those who state that scalp sampling is of no benefit are the ones who completed a residency when EFM and sampling were not available. I am a proponent of scalp sampling since for the past 22 years it has helped me avoid many unnecessary cesarean deliveries (for abnormal FHR tracings). A variable deceleration has a variable shape, variable onset, variable duration. A common mistake is to classify a variable (abrupt drop and recovery) deceleration which occurs after the contraction as a "late".

LSR

At Mon, 27 Nov 2000, Garry Siegel wrote: >
>Here's a issue from left field: I don't think that I have a current text
>that addressed fetal monitoring, and I'm not really sure that I've
>attended any update/etc. that addresses the nuances of interpreting
>fetal monitoring since residency long, long ago.
>
>That said, I realize that interpreting strips is very subjective, and
>that fetal pulse ox (just heard an hour talk by Frank Boehm, Vanderbilt,
>about them--looks like we won't rely on monitors as much, I bet) may
>make monitoring history.
>
>Anyway, today I had an obese, insulin requiring gestational diabetic in
>labor. She was a primip at term, early labor at 2-3 cm/70%, due
>tomorrow, hurting, and not going home.
>
>AROM--meconium, internals placed, and when she didn't progress or
>contract enough, pit started. She had a normal strip, got an epidural,
>and then had recurrent lates, kind of deep, for about 45 minutes, with a
>loss of BTBV. The nurse didn't get too excited, saying that while they
>were deep, they came up ok, and then got "better" because they weren't
>as deep. The pit was stopped, fluids/Oxygen given, hypotension (a tiny
>bit) from the epidural corrected.
>
>The strip got better, meaning no decels, but no accels, poor BTBV, with
>the Pit off, and she wasn't contracting. BTW, she was 4 to 5/70/high,
>at about 3:30 PM--meaning that she has gone from 2-3 at 0830 to 4-5 by
>1530!
>
>So, after discussion, the pit was started, the BTBV a bit better, no
>accels, contractions more frequent, and she had intermittent decels. As
>I had discussed with the patient, if we restarted the pit, and the strip
>began to "worsen"--whatever that means--then it was C/S time. OR trip,
>8 pound, 14 oz. baby, Apgars 8/8.
>
>So, why did I present this? I was raised that a decel that was late
>typically started at the contraction's peak, and lasted beyond the
>contraction. However, if the form of the decel looked like a Nike
>swoosh, even if timed with the contraction, and no matter how deep, it
>was a late. The nurses seemed to think that a small decel--5 beats
>below the baseline in the form/morphology of a typical late, but that
>ended as the contraction finished, was of no concern?
>
>How do you decide? Who has a good book/website with pix?
>
>Garry
>
>--
>Garry E. Siegel, M.D., F.A.C.O.G.
>Roswell, GA
>Private Practice
>

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