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Re: Fetal Pulse Oximetery From: ainsron@msn.com Mon Jul 23 19:39:28 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Jane Helwig, MD : "Re: Aygestin" Previous message: Larry Glazerman: "Re: Fetal Pulse Oximetery" In reply to: Yankowitz, Jerome: "Re: Fetal Pulse Oximetery" Next in thread: Dr Don Miller: "Re: Fetal Pulse Oximetery" Reply: Dr Don Miller: "Re: Fetal Pulse Oximetery" Interestingly, after looking at the demo in L&D today and sending this post, I looked at my July Contemporary OB/GYN and lo and behold, there was an article by Garite on the very subject! Funny how things work out. It gives a good overview. An RCT from nine centers in the US, published in the Am J of Obstet Gynecol, 2000, demonstrated that EFM plus oximetry reduced C/S rate for non-reassuring FHR patterns from 10% to 5%, but there was no overall reduction in the C/S rate because of a higher rate of C/S for dystocia in these patients! (I guess some patients are simply destined to have a C/S, no matter what we do.) The most interesting part of the article to me was a side bar by a lawyer discussing the medicolegal perspective, especially the first paragraph: "When a new technique or device is introduced, there is a period between the time it first becomes available and its adoption as 'standard of care' - if that is possible. That time frame is of legal significance. During this window, a physician may be sued for not having used the device when it was available and may be held liable for a bad outcome, assuming there is evidence that the device would have provided information that would have made a difference in management. We are at this juncture with fetal pulse oximetry. While the standard is cloudy, the physician may also be sued for using a device and accused of delatying delivery and allegedly causing damage to the fetus." So looks like we are damned if we do and damned if we don't!! >Of no proven benefit > >> Jerome Yankowitz, MD >> Director, Division of Maternal-Fetal Medicine >> and Fetal Diagnosis and Treatment Unit >> Dept of OB/GYN >> Univ of Iowa Hospitals and Clinics >> Telephone: 319-356-2574 >> Fax No: 319-353-6759 >> >> ---------- >> From: Braun, R. Daniel >> Reply To: ob-gyn-l@obgyn.net >> Sent: Monday, July 23, 2001 2:34 PM >> To: Multiple recipients of list OB-GYN-L >> Subject: RE: Fetal Pulse Oximetery >> >> The last time I talked with Frank Boehm, he said it was good for #2 below >> in both settings. You would use it in cases where you should have used >> scalp >> pH in the past. >> >> Dan >> R. Daniel Braun, MD >> >> "If everybody likes you, you've got to be doing something wrong." >> Kinky Friedman >> >> -----Original Message----- >> From: ainsron@msn.com [mailto:ainsron@msn.com] >> Sent: Monday, July 23, 2001 3:43 PM >> To: Multiple recipients of list OB-GYN-L >> Subject: Fetal Pulse Oximetery >> >> We all know the criticism of how rapidly the technology of fetal >> monitoring took off and how later evidence has been not so supportive of >> its general use. On the other hand we also know how useful pulse >> oximetry has been in evaluation of patients undergoing general >> anesthesia or IV sedation, and that is negligent to not use it in those >> settings. Our ob unit manager wants input on the proposed purchase of a >> fetal pulse oximetry unit. It requires the committment to use/purchase >> at least six electrodes monthly at ~$150 apiece. They will allow us to >> have two months to try it out and see if we want to continue the >> contract. What is the consensus regarding this new modality of fetal >> monitoring? >> 1) simply a new toy without significant benefit >> 2) Useful for preventing cesarean sections for non-reassuring FHR >> tracings: in a community hospital? in a university hospital? >> 3) absolutely necessary for the modern obstetrical unit. >> 4) Research tool without enough direct evidence of benefit. >> 5) Needs more study before common use. >> 6) Are you currently using one or planning to acquire one? >> >> thanks for your input >> >> -- >> Ronald E. Ainsworth, MD >> -- Ronald E. Ainsworth, MD Next message: Jane Helwig, MD : "Re: Aygestin" Previous message: Larry Glazerman: "Re: Fetal Pulse Oximetery" In reply to: Yankowitz, Jerome: "Re: Fetal Pulse Oximetery" Next in thread: Dr Don Miller: "Re: Fetal Pulse Oximetery" Reply: Dr Don Miller: "Re: Fetal Pulse Oximetery"

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