Re: 34 week prom
From: art fougner, md (evsono@pipeline.com)
Fri Apr 8 12:47:05 2005
Dan
thanks - agreed re sign of infection - of course the diagnosis of labor
is often tricky even with digital exams.
Art
At Fri, 8 Apr 2005, R. Daniel Braun wrote:
>
>Regular contractions will suffice in this situation. Also onm
>e can do speculum exams if really worried about it. but in this
>situation, regular contractions would be a sign of infection an an
>indication for delivery.
>Dan
>
>On Apr 8, 2005 8:11 AM, art fougner, md <evsono@pipeline.com> wrote:
>> Dan ...
>>
>> in this setting, without digital exams ... please define labor.
>>
>> Art
>>
>> At Fri, 8 Apr 2005, R. Daniel Braun wrote:
>> >
>> >I would manage by doing
>> >
>> >1. NO digital vaginal exams,
>> >2. Ampicillin
>> >3. Steroids
>> >4. Observation IN HOSPITAL until:
>> > A. Reaches 37 weeks or
>> > B. Shows signs of infection.
>> >
>> >My observation in addition to Temperature recording would include a
>> >daily 10 min FHR strip for BASELINE FHR. The baseline FHR will
>> >increase prior to most other signs of infection. Would also daily
>> >palpate for tenderness. Labor in a patient with ROM may well be a sign
>> >of infection and hence an indication for delivery.
>> >
>> >Dan
>> >
>> >On Apr 7, 2005 7:58 PM, Robert J. Carpenter, Jr. MD <zygote@icsi.net> wrote:
>> >> Not if I have my say and nature is cooperative with no labor, no infection, etc.
>> >>
>> >> On 7 Apr 2005 at 12:20, Richard Chudacoff, MD wrote:
>> >>
>> >> > What did the MFMs want you to do? In one of my intuitions they want
>> >> > them delivered at 34 weeks
>> >> >
>> >> > Richard Chudacoff, MD
>> >> >
>> >> > -----Original Message-----
>> >> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>> >> > Andrew Folley Sent: Thursday, April 07, 2005 11:16 AM To: Multiple
>> >> > recipients of list OB-GYN-L Subject: RE: 34 week prom
>> >> >
>> >> > Question: Had a patient show up last night G3P2 ruptured membranes 34
>> >> > weeks
>> >> >
>> >> > 1 day. 2 prior c-sections. Not in Labor. What to do? She is vertex
>> >> > fluid in vault sent for f-pole showed not mature. My plan was
>> >> > steroids, tocolysis
>> >> >
>> >> > for 48 hours if necessary and repeat c-section in 48 hours.
>> >> > Along with GBS prophylaxis. Some of our MFMs were not so happy with
>> >> > the management plan. What ywoud you do???? andy
>> >> >
>> >> > >
>> >> >
>> >> > _________________________________________________________________
>> >> > _________________________________________________________________
>> >> > _________________________________________________________________
>> >> >
>> >>
>> >> Robert J. Carpenter, Jr. MD
>> >> 6624 Fannin, #2720
>> >> St. Luke's Medical Tower
>> >> Houston,TX 77030-2339
>> >> 713-795-4600
>> >>
>> >--
>> >R. Daniel Braun
>> > Kinky for Governor
>> >
>>
>> --
>> art fougner, md
>>
>> "If you don't know where you are going, you will wind up somewhere else."
>> Lawrence Peter Berra
>>
>--
>R. Daniel Braun
> Kinky for Governor
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
