Re: New Case
From: Braun, R. Daniel (rbraun@iupui.edu)
Tue May 28 07:39:17 2002
Your nurses and lab are better than ours.
R. Daniel Braun, MD
There are strange things done in the midnight sun
By the men who moil for gold;
The Arctic trails have their secret tales
That would make your blood run cold;
The Northern Lights have seen queer sights,
But the queerest they ever did see
Was that night on the marge of Lake Lebarge
I cremated Sam McGee.
Robert W Service
-----Original Message-----
From: eramirezt@coqui.net [mailto:eramirezt@coqui.net]
Sent: Tuesday, May 28, 2002 6:47 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: New Case
Yes - $20 - haven't seen a case you mentioned in 20 years - I have been
lucky - they have always benefited me - >
At Tue, 28 May 2002, Braun, R. Daniel wrote:
>
>What happens with a screaming apgar 9/9 baby and the cord pH comes back
>6.5? Obviously error in collecting or running the test, right?? OK, What
if
>apgars 9/9 and pH 6.95? still error??????????? With a pink, screaming
>baby, cord gases can only hurt YOU. And YOU are the only one for whom cord
>gases are of any benefit. And your patient pays for them.
>
>R. Daniel Braun, MD
>
>There are strange things done in the midnight sun
> By the men who moil for gold;
>The Arctic trails have their secret tales
> That would make your blood run cold;
>The Northern Lights have seen queer sights,
> But the queerest they ever did see
>Was that night on the marge of Lake Lebarge
> I cremated Sam McGee.
> Robert W Service
>
> -----Original Message-----
>From: eramirezt@coqui.net [mailto:eramirezt@coqui.net]
>Sent: Monday, May 27, 2002 9:45 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: New Case
>
>Nothing different - except that, I have no experience with Stadol and I
>would have taken cord gases - I do them to all babies but I know that it
>is not standard of care ...yet.
>
>>At Sat, 25 May 2002, Len2976@aol.com wrote:
>>
>>Last weekend I had a patient--G3, P2 at 39+ weeks--who presented to L & D
>>with irregular UC's. She was 4 cm dilated, 50% effaced, vtx at -3
>>station--but not applied to the cervix. After a few hours of ambulation
>and
>>showering, she was unchanged. After a review of options (home,
>observation,
>>augmentation) and MD consultation, she opted for pitocin augmentation.
>>
>>Pitocin was started and after about 2 hrs, AROM (clear AF) was performed.
>>Labor progressed steadily and she delivered about 4 hours after pitocin
was
>>started.
>>
>>FHR tracing revealed excellent BTBV prior to initiation of pitocin--the
>only
>>periodic changes were accelerations and mild early decelerations. The
>>patient did not want an epidural and instead got IV stadol for pain
>>management. After the stadol, BTBV was markedly decreased--to the point
of
>a
>>absent BTBV for several minutes at a time. Although we often see a
>decrease
>>in BTBV after stadol, this "flat line" was not common. During this time,
>the
>>only periodic changes were early decelerations.
>>
>>I closely observed for any abnormal periodic changes--there were
>>accelerations with fetal scalp stimulation--which I found reassuring.
>>Delivery occurred quickly after 6 cms. The infant had apgar scores of
9/9.
>>However, we immediately noted that the breathing sounded very strange (not
>>grunting, no retractions, but very congested) and he had a high-pitched
>cry.
>>He also had one club foot.
>>
>>In the nursury, his O2 sats were in the mid 80's and oxygen was started
via
>>hood. In order to keep the O2 sats up, the nurse had to hyperextend his
>>neck. A narrowed trachea was suspected by the pediatrician. There also
>>appeared to be the appearance of abnormal positioning--while the infant's
>>upper extremities were flexed, his legs were straight.
>>
>>He was transferred later that morning to the nearby neonatal ICU. I have
>>kept in touch with the family and have learned the following: The problem
>>with the trachea is not due to narrowing, but due to poor muscle tone--his
>>neck must still be in specific positions for good air exchange. His EEG
is
>>abnormal and he is on anti-convulsants. Spinal fluid revealed "something"
>>abnormal which has led them to do a muscle biopsy. Muscular Dystrophy was
>>mentioned as a possibility.
>>
>>Questions to the group--
>>Has anyone heard of diagnosing muscular dystrophy this early?
>>Should the total loss of BTBV have sent up a bigger "red flag?"
>>Would anyone have managed L&D differently?
>>Go on--give it to me--I have a thick skin. Although I have been a CNM for
>26
>>years, I have had very few poor outcomes and they still bother me.
>>
>>Lenora mcCall, CNM
>
>--
>"Life is neither the notes nor the silence between the notes, but the music
>that
> arises out of sound and silence felt as a living whole. Stop
>choosing...between
> chaos and order, and live at the boundary between them, where rest and
>action
> move together..." David Whyte
>
--
"Life is neither the notes nor the silence between the notes, but the music
that
arises out of sound and silence felt as a living whole. Stop
choosing...between
chaos and order, and live at the boundary between them, where rest and
action
move together..." David Whyte
