Re: Auscultation of the FH between spinal and incision in elective C/S
From: art fougner, md (evsono@pipeline.com)
Fri May 16 10:00:58 2008
Probably best to continue through the first twenty yrs of life.
Art
At Fri, 16 May 2008, R. Daniel Braun wrote:
>
>Notice the guidelines say it should CONTINUE until the abdomen is prepped.
>i.e. during spinal or epidural placement.
>
>Dan
>
>On Fri, May 16, 2008 at 6:01 AM, Efrain Ramirez <eramirezt@coqui.net> wrote:
>
>> We always do an NST prior elective C/S - saw a patient Friday - perfect
>> everything.. early Monday morning she presented with severe - I mean
>> long profound decelerations ... C/S was obviously done at a much faster
>> pace.. APGAR 7/8 with a pH 7.0 something.. found nothing unusual.. one
>> wonders.
>>
>> >From ACOG's Guidelines for Perinatal Medicine
>>
>> In women requiring cesarean delivery, fetal surveillance should continue
>> until abdominal sterile preparation has begun. If internal fetal heart
>> rate monitoring is in use, it should be continued until the abdominal
>> sterile preparation is complete. Consideration should be given to the
>> use of antiembolic elastic stockings or pneumatic compression boots in
>> women considered at high risk for venous thromboembolism. When the
>> cesarean delivery is performed for fetal indications, consideration
>> should be given to sending the placenta for pathologic evaluation.
>>
>> Ef
>>
>> At Fri, 16 May 2008, Raymond Stephen wrote:
>> >
>> >I would be interested to hear of an example of a case where the
>> >monitoring led to your doing something different from what had been
>> >planned.
>> >
>> >Steve
>> >
>> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R.
>> >Daniel Braun
>> >Sent: Thursday, 15 May 2008 9:14 PM
>> >To: Multiple recipients of list OB-GYN-L
>> >Subject: Re: Auscultation of the FH between spinal and incision in
>> >elective C/S
>> >
>> >When I was still practicing, I insisted on continuing to monitor the FHR
>> >during and after spinal placement. These are the times that it may be
>> >most beneficial to monitor.
>> >
>> >Dan
>> >
>> >On Thu, May 15, 2008 at 6:45 AM, Charles Bloom <cdsb@bellsouth.net>
>> >wrote:
>> >
>> >We monitor the FHR only if there is going to be a delay. If you proceed
>> >immediately with Cesarean, any attempt to monitor the FHR delays
>> >delivery.
>> >Write your policy accordingly.
>> >
>> >Charles
>> >
>> >-----Original Message-----
>> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of John
>> >Robertson
>> >Sent: Wednesday, May 14, 2008 10:11 PM
>> >To: Multiple recipients of list OB-GYN-L
>> >
>> >Subject: Auscultation of the FH between spinal and incision in elective
>> >C/S
>> >
>> >There is an effort by non-physicians in our hospital to introduce a
>> >nursing practice guidline requiring the auscultation of the fetal heart
>> >after administration of the spinal anaesthetic and prior to the skin
>> >incision in all elective cesarean sections. I have questioned the logic
>> >of this for several reasons, but rather than biasing the thread further,
>> >I would be interested in what others think. I would be especially
>> >interested in any science for or against this. John.
>> >
>> >--
>> >J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
>> >
>> >(604) 793-9988 e-mail john.robertson@obgyn.net
>> >Who is wise and understanding among you? Let him show it by his good
>> >life,
>> >by deeds done in the humility that comes from wisdom. James 3 vs 13,
>> >NIV
>> >
>> >--
>> >R. Daniel Braun, MD FACOG(L) ABMP CMTh
>> >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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>>
>> --
>> "I can accept failure, but I can't accept not trying." - Michael Jordan
>>
>--
>R. Daniel Braun, MD FACOG(L) ABMP CMTh
>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
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
