Re: 'There is no gold standard for decision-to-incision time' ???
From: R. Daniel Braun (rd.braun@gmail.com)
Mon Oct 8 18:36:49 2007
I was assuming the use of either a scalp electrode or looking with an US and
seeing a still heart. In my practice, I wanted to have good evidence of
fetal life less than 5 minutes before the incision. With fetal distress
especially, I would have a scalp electrode on and leave it on until the
uterine incision. At that time I would have the nurse or resident remove it
under the drapes.
If the distress was getting worse and Anesthesia was the one missing, I have
on one occasion done the section under local. (Not ideal but we got a good
baby) 20 minutes later, the anesthesiologist got there and we were standing
with the abdomen open and minimal to no bleeding waiting for him before we
started to repair the uterus.
Dan
On 10/8/07, Andrew Folley <agfolley@hotmail.com> wrote:
>
> You could make the argument this baby has just died as in the past 5
> minutes and possibllity of resussitation exists. One could also make the
> argument that the fetal herart tones being "absent" may be incorrect. ie it
> is inaccurate and you are simply recording the fetal heart rate in distress
> of the baby at 90 the same as moms very anxious heart rate andy
>
> ------------------------------
> Date: Sun, 7 Oct 2007 18:38:09 -0500
> ------------------------------
> From: rd.braun@gmail.com
> ------------------------------
> To: ob-gyn-l@dns.obgyn.net
> Subject: Re: 'There is no gold standard for decision-to-incision time' ???
>
> If your indication for the section is fetal distress, certainly. You no
> longer have that indication. Or do you section people for a dead baby?
>
> Dan
>
> On 10/7/07, * Raymond Stephen* <stephen.raymond@dhhs.tas.gov.au> wrote:
>
> So if you find there are no fetal heart sounds as the last person
> arrives, what do you do then? Stand down the team and allow to deliver
> vaginally?
>
> Steve
>
> ------------------------------
> *From:* ob-gyn-l@obgyn.net [mailto: ob-gyn-l@obgyn.net] *On Behalf Of *R.
> ------------------------------
> Daniel Braun
> ------------------------------
> *Sent:* Sunday, 7 October 2007 12:11 PM
> *To:* Multiple recipients of list OB-GYN-L
> *Subject:* Re: 'There is no gold standard for decision-to-incision time'
> ???
>
> Question relating to the case presented. How long from last listening for
> FHT's and incision? It is easy to stand around in the OR waiting for that
> last member of the team to arrive and then just make the incision when they
> get there. One should always know whether or not there is a heart beat
> before making the incision. IMHO.
> With a one and 5 minute apgar of "0", I find it hard to believe that there
> were ht. tones present in the last 3-5 minutes befor the incision.
>
> Dan
> On 10/6/07, *Efrain Ramirez* <eramirezt@coqui.net> wrote:
> There is no gold standard for decision-to-incision time
> Don't accommodate plaintiff's attorneys who have reinvented an intended
> guideline as a requirement!
>
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> --
> R. Daniel Braun, MD FACOG(L) CMT
> Professor Emeritus
> Dept. of Obstetrics and Gynecology
> Indiana U. School of Medicine
>
> R. Daniel Braun
>
> "Science without Religion is LAME; Religion without Science is
> BLIND"
> Einstein 1941
>
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> Peek-a-boo FREE Tricks & Treats for You! Get 'em!<http://www.reallivemoms.com?ocid=TXT_TAGHM&loc=us>
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--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
