Re: Clinical scenario
From: Joe (forcep@intercom.net)
Mon Oct 9 15:48:16 2006
Correct: not just "changes in cervix". Joe C
Larry Glazerman wrote:
> Joe:
>
> The way I understand it is "regular cervical contractions causing
> progressive dilatation of the cervix."
>
> Larry R. Glazerman, MD
> Ob-Gyn at Trexlertown, PC
> larry.glazerman@lvh.com
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joe
> Cutchin
> Sent: Monday, October 09, 2006 11:34 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Clinical scenario
>
> Larry: I thought it included "progressive dilatation of cervix" . I am
> being picky because this gets into courts ,ie was she in labor or not. Joe C
>
> Larry Glazerman wrote:
>
>>To play devil's advocate, Friedman's data applied to patients who are in
>>labor. Labor is defined as regular contractions that cause cervical
>>change. The reason that this s a dilemma is that it's not clear that the
>>patient is in labor. If she were definitely in labor, there wouldn't be
>>a controversy.
>>
>>Having given up OB a year ago, I don't have an opinion on management,
>>just wanted to clarify the semantics of the issue.
>>
>>Larry R. Glazerman, MD
>>
>>Ob-Gyn at Trexlertown, PC
>>
>>larry.glazerman@lvh.com
>>
>>------------------------------------------------------------------------
>>
>>------------------------------------------------------------------------
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Julio
>>------------------------------------------------------------------------
>>Arellano
>>Sent: Monday, October 09, 2006 10:47 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Clinical scenario
>>
>>Dear listmates:
>>
>>The starting point is to define this patient's status, that is, if she
>>is or not in labor. After 5 cm, according with Friedman's partogram, is
>>a latent phase of the first stage, which become prolonged if exceeds 20
>>hours in the nullipara or 14 hours in the multipara. With GBS risk
>>unknow, and so close to the 37 weeks, I agree with El, AROM or oxytocin.
>>
>>Dr. Julio C. Arellano
>>
>>La Plata. Bs As. Argentina
>>
>>arellano@netverk.com.ar <mailto:arellano@netverk.com.ar>
>>
>>-------Mensaje original-------
>>
>>De: Elrod, Darryl G Maj 48 MDOS/SGOBO
>><mailto:Darryl.elrod@LAKENHEATH.AF.MIL>
>>
>>Fecha: 10/08/06 13:30:57
>>
>>Para: Multiple recipients of list OB-GYN-L <mailto:ob-gyn-l@dns.obgyn.net>
>>
>>Asunto: Clinical scenario
>>
>>I thought I'd ask a clinical question to get away from the Op Ed debate
>>for a bit.
>>
>>28 yo G2P1 shows up to our midwife at 36+2 wks for her GBS testing. Her
>>last delivery was at 37 wks and she is feeling a bit of pressure. No
>>regular contractions, just some irregular cramping. She happens to live
>>about 30 minutes from the hospital. On exam the midwife finds that she
>>is 4-5cm/75% and -2 station.
>>
>>Given the history of preterm delivery, the distance from the hospital
>>she admits her to the ward.
>>
>>The next morning, still no regular contractions but is checked again and
>>is 5-6cm. She doesn't appear to be 'actively' in labor so we sit tight.
>>
>>Hospital day 2 (now 36+4) she is checked again and is 6-7cm. The next
>>morning at 36+5 she is 8cm but still no regular contractions, no
>>bleeding, no leaking fluid.
>>
>>We have a group discussion about her care and come up with several
>>different options.
>>
>>For sake of argument, who would
>>
>> 1. call her in labor and deliver her now.
>> 2. Wait for her to actually go into 'labor' since she is technically
>> preterm
>> 3. Amnio her and deliver if mature
>> 4. Give her steroids and deliver in 48 hours
>> 5. Deliver her at 39 weeks if she is still pregnant, but keep her
>> admitted until then.
>>
>>Hope this spurs some debate of a different kind.
>>
>>Glen
>>
>>//SIGNED//
>>
>>D. Glen Elrod, Maj., USAF, MC
>>
>>Obstetrician/Gynecologist
>>
>>Chief of Obstetrics
>>
>>48 MDOS/SGOBO
>>
>>RAF Lakenheath, England
>>
>>Telephone DSN: 314-226-8130
>>
>> Comm: +44 (0) 1638 52 8130
>>
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