Re: OB-GYN-L digest 4115
From: R. Daniel Braun (rd.braun@gmail.com)
Sun Aug 28 14:22:45 2005
Delivery by the most expeditous route.
On 8/28/05, RModugno@aol.com <RModugno@aol.com> wrote:
>
> In a message dated 8/28/2005 1:18:44 PM Eastern Standard Time,
> Huladoula1@aol.com writes:
>
> and in another we don't.
>
> Who is "we?" In many areas "we' is the malpractice insurer and/or the
> hospital - both "practicing medicine' without a licence.
> American obstetricians practice their profession under a veil of fear -
> fear of malpractice litigation. No LM, CNM, NP, PA, RNC, Doula or consumer
> of women's healthcare can imagine the shoes in which we walk!
> So, if an obstetrician perceives that a situation may lead to a lawsuit,
> increased premiums, cancelling of their liability insurance , premature
> termination of their career, loss of hospital privileges and personal assets
> - which pathway do you think they are going to choose? Which would *you*choose!
> The consumers can bitch and moan till the cows come home - it just ain't
> gonna happen in this climate!
> Her's an example from the real world (happened last night): The patient,
> a medical student surrounded by her support team of 2 other med students and
> a law student develops late decelerations on pitocoin. The pitocin is
> switched off. She has an epidural, is seven centimeters dilated, a
> primigravida at term with clear amniotic fluid.. Following this incident the
> baby then develops a baseline tachycardia in the 180s. She is afebrile.
> There is no apparent "external" cause for this shift from the previous
> baseline in the 120s. I would expect a "compensatory" tachycardia to resolve
> within a few minutes.After 15 minutes of watching this tachycardia, it
> persists. What should I do? Continue to watch? Restart pitocin? There are no
> further decelerations and naturally reactivity is gone because of the
> tachycardia. Some seminal event has occured? Now what?
> Robert Modugno MD MBA FACOG
> Marietta, GA
>
--
R. Daniel Braun
Kinky for Governor
