-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: OB: What is a late deceleration? (case and discussion--long) From: Efrain Ramirez (eramirez@icepr.com) Tue Nov 28 16:22:53 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Dutch Approve Euthanasia Law, Spark Critics" Previous message: Braun, R. Daniel: "FRIDAY: Making the world safer" In reply to: Garry Siegel: "OB: What is a late deceleration? (case and discussion--long)" Next in thread: John Robertson MD: "Re: OB: What is a late deceleration? (case and discussion--long)" Fogot to ask -- was there a nuchal cord? - Also -sometimes amnioinfusion helps - if you believe some articles --;-) Amnioinfusion for umbilical cord compression in labour (Cochrane Review) Hofmeyr GJ ABSTRACT A substantive amendment to this systematic review was last made on 19 October 1997. Cochrane reviews are regularly checked and updated if necessary. Background: Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. Objectives: The objective of this review was to assess the effects of amnioinfusion on maternal and perinatal outcome for potential or suspected umbilical cord compression or potential amnionitis. Search strategy: The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Selection criteria: Randomised trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression; and women at risk of intrauterine infection. Data collection and analysis: Eligibility and trial quality were assessed by the reviewer. Main results: Twelve studies were included. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: fetal heart rate decelerations (relative risk 0.54, 95% confidence interval 0.43 to 0.68); caesarean section for suspected fetal distress (relative risk 0.35, 95% confidence interval 0.24 to 0.52); neonatal hospital stay greater than 3 days (relative risk 0.40, 95% confidence interval 0.26 to 0.62); maternal hospital stay greater than 3 days (relative risk 0.46, 95% 0.29 to 0.74). Transabdominal amnioinfusion showed similar results. Transcervical amnioinfusion to prevent infection in women with membranes ruptured for more than 6 hours was associated with a reduction in puerperal infection (relative risk 0.50, 95% confidence interval 0.26 to 0.97). Reviewers' conclusions: Amnioinfusion appears to reduce the occurrence of variable heart rate decelerations and lower the use of caesarean section. However the studies were done in settings where fetal distress was not confirmed by fetal blood sampling. The results may therefore only be relevant where caesarean sections are commonly done for abnormal fetal heart rate alone. The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion. Citation: Hofmeyr GJ. Amnioinfusion for umbilical cord compression in labour (Cochrane Review). In: The Cochrane Library, 4, 2000. Oxford: Update Software. 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 > -- "Do not take life too seriously. You will never get out of it alive." Marianne Williamson Next message: Efrain Ramirez: "Dutch Approve Euthanasia Law, Spark Critics" Previous message: Braun, R. Daniel: "FRIDAY: Making the world safer" In reply to: Garry Siegel: "OB: What is a late deceleration? (case and discussion--long)" Next in thread: John Robertson MD: "Re: OB: What is a late deceleration? (case and discussion--long)"

Return to

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 04:46:23 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.