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Re: OB: What is a late deceleration? (case and discussion--long)From: Garry Siegel (garrys@mindspring.com)Tue Nov 28 19:47:41 2000
Thanks for all of the comments and help. Some replies:
> Heaven knows if I can actually scan it, and post it. However, at the site http://www.sgvpmg.com/images/late.gif it shows typical lates. My decels had the exact same morphology (shape) but did start sooner in the contraction, and was over a few seconds after the contraction was over. snipped LSR:
There is no way to tell from your description whether these
>were late or variable decelerations.
A common mistake is to classify a variable (abrupt drop and
>recovery) deceleration which occurs after the contraction as a "late". GES: I think most of us would call these lates, or at least real odd variables. Someone asked about a cord gas. I vacilate between doing them whenever the strip is bad (and thus the reason for a section/op vaginal delivery), or if there is MSAF, versus not doing them purposefully when the Apgars are good. In this case, the Apgars were good, 8/8, and I didn't do one--retrospectively, I should have for educational/maybe legal purposes. LSR mentioned scalp pH--I grew up with them, but use them rarely in private practice. Luis, most of the private patients don't take kindly to nicking junior's head a few times, and whether rationally or not, would rather have a large nick on their abdomen rather than "take any chances" with the baby. Right or wrong, do remember that this was a gestational diabetic with meconium from AROM with a strip that wasn't squeaky clean normal. It would be a bit hard to defend if junior wasn't perfect. . . Fetal pulse ox: A nice talk by Frank Boehm, one of the investigators. It was amazing to see some awful strips with tachycardia/lates whose fetal 02 was normal. Of course, he only showed good examples :) That said, his pilot study did not drop the section rate. In the pulse ox group (used only when the strip was "bad", I think), the section rate overall was unchanged; however, more were done for CPD, and less for distress. This asks the question: Does impending CPD (meaning they've not labored long/hard enough to be sectioned) make the strip bad, such that we sometimes section them for distress, but if we hadn't, they would get CPD later? Will pulse ox "unmask" more CPD that we never found because we sectioned them earlier for fetal reasons? Garry
-- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice
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