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Re: decell Follow up From: Andrew Folley (agfolley@hotmail.com) Fri Dec 21 09:01:36 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff: "Re: active tracing with decell" Previous message: DoctorJoe@aol.com: "Re: active tracing with decell" In reply to: art fougner, md: "Re: active tracing with decell" Next in thread: Richard Chudacoff: "Re: active tracing with decell" Follow up Appreciate the input. Some diversity but the concesus seems to be for delivery. As follow up info. She had extended monitoring (one hour) on Wednesday (I saw her Tuesday) and she had doppler flow of cord which was normal for what it is worth. Still pregnant at this point and coming to office today for monitoring. Good arguments on both sides. I am inclined to stress the baby with an "extended OCT" ie several hours of induction and if the baby is fine to delay delivery. She is just about 34 weeks I think the steroids may be a good choice as well. I could see inducing her for 18 hours (primip unripe cervix) and having no decells etc and ending up with premie on delivery. Alternative is a csection now. Basically behind the 8 ball. This is one of those situations where you wish you had never done the NST to begin with. I suspect lots of babies experience intermittent decells lasting minutes that we simply are unaware of?? Keep you and my lawyers posted. agf> Date: Fri, 21 Dec 2007 08:26:59 -0600> From: evsono@pipeline.com> To: ob-gyn-l@dns.obgyn.net> Subject: Re: active tracing with decell> > Cautionary tale: Obtaining a consult does not absolve the referring> physician of responsibility. It merely adds yet another name to the> summons. Of course, I practice in NY, so your local situation may be> better.> > Art> > At Thu, 20 Dec 2007, Joanne Bulley, MD wrote:> >> >Only if the fetus survives the trip to the MFM while out of your care> >but not yet in the MFM's care!> >> >Joanne> >> >(being devilish)> >> >At Thu, 20 Dec 2007, Richard Chudacoff wrote:> >>> >>Ah, but the latter absolves me of all responsibility :-)> >>> >>--> >>Richard Chudacoff, MD, FACOG> >>> >> _____> >>> >>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R. Daniel> >>Braun> >>Sent: Thursday, December 20, 2007 6:11 AM> >> To: Multiple recipients of list OB-GYN-L> >>Subject: Re: active tracing with decell> >>> >>I'm not so sure that the 3rd one is such a good one though.> >>> >>So Andrew,> >>What have you done???? Do you know the outcome, yet?> >>> >>Dan> >>> >>On Dec 20, 2007 8:18 AM, Richard Chudacoff, MD < rchudacoff@mylinuxisp.com>> >>wrote:> >>> >>For me the solution is simple. I have a healthy baby now. I do not know, if> >>she leaves L&D, that I will still have a healthy baby n 24-48 hr. So I> >>believe only three options exist: deliver, continuous monitoring on L&D> >>until delivery, transfer to MFM.> >>> >>Richard Chudacoff, MD, FACOG> >>-sent from my Treo 650> >>> >>-----Original Message-----> >>> >>From: "Raymond Stephen" < Stephen.Raymond@dhhs.tas.gov.au> >><mailto:Stephen.Raymond@dhhs.tas.gov.au> >> >>Subj: RE: active tracing with decell> >>Date: Wed Dec 19, 2007 10:04 pm> >>Size: 2K> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >><mailto:ob-gyn-l@dns.obgyn.net> >> >>> >>Compare the number of times you have seen a true knot at delivery of a> >>well child and the number of cases of intrauterine death due to a true> >>knot. Further, because of the turgidity of the cord due to its blood> >>pressure there is room for doubt that cord accidents are the cause of> >>death rather than the antecedent of death from other blood flow> >>problems.> >>> >>Steve> >>> >>________________________________> >>> >>________________________________> >>From: ob-gyn-l@obgyn.net [ma lood flow> >>problems.> >>> >>Steve> >>> >>________________________________o:ob-gyn-l@obgyn.net] On Behalf Of> >>> >>--> >>________________________________> >>westsidebirthservice@juno.com <mailto:westsidebirthservice@juno.co= o:ob-gyn-l@obgyn.net] On Behalf Of> >>> >>--> >>___________________________m>> >>________________________________> >>Sent: Thursday, 20 December 2007 1:50 AM> >>To: Multiple recipients of list OB-GYN-L> >>Subject: Re: active = m>> >>________________________________> >>Sent: Thursday, 20 December 2007 tracing with decell> >>> >>Could be true knot that isn't fatal. Your'e going to deliver "just in> >>case?"> >>> >>Just wondering where the dividing line is between the "every birth is a> >>disaster waiting to happen and can't be diagnosed as normal until after> >>the event" and "birth is a natural event with some fatal outcomes due to> >>(someties cord) accidents." And what of the sequela of delivering a> >>preterm baby because of the fear of a fatal cord accident?> >>> >>Louana> >>> >>-- Joe <forcep@intercom.net <mailto:forcep@intercom.net> > wrote:> >>Excellent point, Dan. Could have true knot which could be fatal. Joe C> >>> >>R. Daniel Braun wrote:> >>> That makes no sense at all. If you have cord entanglement> >>> >>theoretically> >>> it could at any time become so severe that it kills the baby. So> >>> logically you have to either monitor her continuously until delivery> >>or> >>> ignore it. NST's and CST's don't predict anything about cord problems,> >>> >>> only about UPI. Therefore they are of no benefit.> >>>> >>> IMHO> >>> Dan> >>>> >>> On Dec 18, 2007 8:05 PM, Raymond Stephen> >>> <Stephen.Raymond@dhhs.tas.gov.au> >>> <mailto: <mailto:Stephen.Raymond@dhhs.tas.gov.au>> >>> >>Stephen.Raymond@dhhs.tas.gov.au>> wrote:> >>>> >>> And, you're going to mess up her sugars. Ask yourself shy she had> >>the> >>> deceleration - can't be placental insufficiency, no IUGR, so it> From: ob-gyn-l@obgyn.net <mailto:ob-gyn-l@obgyn.net>> >>> [mailto:ob-gyn-l@obgyn.net <mailto: ob-gyn-l@obgyn.net> >><mailto:ob-gyn-l@obgyn.net> >] On Behalf> >>Of> >>> Richard Chudacoff> >>> Sent: Wednesday, 19 December 2007 11:51 AM> >>> To: Multiple recipients of list OB-GYN-L> >>> Subject: RE: active tracing with decell> >>>> >>> That is true, especially in this case with GDM. But hey, that is> >>why I> >>> don't> >>> deliver anymore> >>>> >>> Richard Chudacoff, MD, FACOG> >>>> >>--- message truncated ---> >>> >>--> >>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> >>> >--> >Joanne Bulley, MD, FACOG> >Solo gyn> >Keene, NH USA> >> >more snow on the way!> >> > --> art fougner, md> "May The Wings of Liberty Never Lose a Feather." - Jack Burton Next message: Richard Chudacoff: "Re: active tracing with decell" Previous message: DoctorJoe@aol.com: "Re: active tracing with decell" In reply to: art fougner, md: "Re: active tracing with decell" Next in thread: Richard Chudacoff: "Re: active tracing with decell"

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