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Re: EFMFrom: Atkinson, Samuel M (ATKINSONS@ecu.edu)Tue Jul 10 10:52:17 2007
It is the day after tomorrow. WHAT DID YOU DO AND HOW DID IT END? Or have you not posted the outcomes because one of the parties shot you? sAm -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard D. Kaplan Sent: Monday, July 09, 2007 9:46 AM To: Multiple recipients of list OB-GYN-L Subject: EFM I am the Chief of the Ob/Gyn service at my hospital and was called Sunday morning by the nursing supervisor who felt that an emergency Cesarean section was indicated on one of our laboring patients. The problem was that the attending physician, who was at the bedside, did not agree. The main points of the history were that the patient was a primigravida at 41 weeks. She was admitted Thursday for induction. Her tracing did not show much variability throughout the hospitalization. On Saturday night her cervix was finally ripe enough for AROM which revealed meconium (mod/thick). The physician on call that night did not feel that a C/S was indicated and the induction was continued. On Sunday morning a different attending was on call. That physician reviewed all the previous tracings and felt that the minimal variability and minimal accels (10x10 with scalp stim.) were not significantly different from the previous 48 hours. No periodic decels were ever present. The patient was now finally in active labor (5 cm) and the physician, who was made fully aware (by me and by the nurses themselves) of the nurses' opinion of the tracing, still did not feel that a C/S was indicated. The nurses felt that this baby was clearly hypoxic based on the tracing and that any further delay in delivery was indefensible. They were asking me as Chief to intervene, order a C/S and prevent any further hypoxic injury to this fetus. I would appreciate your (the list's) view on the medical, legal, nurse/doctor/chief relationship, and patient safety issues and principles that this case poses. I can give you the short term outcome tomorrow. Richard Kaplan, M.D.
>----- Original Message -----
> if any of you have had a good course you went to - or good / bad
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