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Re: 24 week-er From: Larry Glazerman (l.glazerman@rcn.com) Mon Jul 10 21:04:56 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley, MD: "Re: colitis and HRT" Previous message: Babycatchers@aol.com: "24 week-er" In reply to: Babycatchers@aol.com: "24 week-er" Next in thread: R. Daniel Braun: "Re: 24 week-er" Reply: R. Daniel Braun: "Re: 24 week-er" Reply: zygote@icsi.net: "Re: 24 week-er" Real tough call - did you have an EFW prior to delivery? How solid were her dates? In my hospital (tertiary center, NICU staff always in house), first of all, our MFMs probably would have taken her in transfer. If she were at our place, the neonatologists would have seen her on admission, discussed the dismal prognosis for a true 23 weeker, and followed the parents' lead. If they wanted full-out resuscitation, they probably would have gone along, but they probably would have advised against it. I'm not an MFM, but isn't 484 grams pretty big for 23 weeks? -- Larry R. Glazerman, MD Ob-Gyn at Trexlertown, PC 610-402-0161 l.glazerman@rcn.com _____ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Babycatchers@aol.com Sent: Monday, July 10, 2006 9:52 PM To: Multiple recipients of list OB-GYN-L Subject: 24 week-er I just need an opinion here. About 2 weeks ago one of our OBs had a 23 week G2P0, SAB@19 weeks come in dilated 4 cm with bulging BOW. He put her in trendelenburg and did a cerclage. A week later she came in with vaginal bleeding and the suture had torn thru the cervix. The referral center would not take her because she was 24 weeks. She camped for several days until her white count went over 26 K with IV antibiotics and SROM. She delivered about 18 hours later. the baby had a heart rate over 120 the whole labor and then spontaneously cried at delivery. The OB did not work the code and documented a 0 apgar at 5 min. The OB nurse did not hart the baby without a heart rate until almost 2 1/2 hrs later and had the ER doc come pronounce since the OB wouldn't come back in. The baby was 484 grams. Spontaneous respirations that lasted at least a couple of minutes. The ped was on the unit at the time of delivery, but the OB did not call her in or call the referral center. I just happened to be there when the heart rate stopped and caught hell from the ER doc for not working the code. So- what would you have done? Do you work the code and punt to the pediatrician? This was 2 weekends ago and there has already been a lawsuit filed. I am not involved, but if (God forbid) it happens while I am the only one on the unit- do I work a code? When I worked at a hosp with a NICU- you always worked if they cried- regardless of weeks. Vicki Smith, CNM, MSN West Virginia Midwives- changing the world one baby at a time. Next message: Joanne Bulley, MD: "Re: colitis and HRT" Previous message: Babycatchers@aol.com: "24 week-er" In reply to: Babycatchers@aol.com: "24 week-er" Next in thread: R. Daniel Braun: "Re: 24 week-er" Reply: R. Daniel Braun: "Re: 24 week-er" Reply: zygote@icsi.net: "Re: 24 week-er"

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