Re: OB: What is a late deceleration? (case and discussion--long)
From: art fougner, md (evsono@pipeline.com)
Tue Nov 28 09:39:11 2000
julian parer has an excellent text on monitoring. additionally, here's
a site with definitions and illustrations - am sure there are others -
http://www.sgvpmg.com/lecture/fhr.htm
the subjectivity of EFM interpretation is the catalyst for the
development of software to aid in this endeavor - funny, reminds me of
counting election results.
art
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
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
