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Re: I have a need for help!!! From: dahmd@gate.net Fri May 17 14:13:59 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Ira Mark Bernstein: "Re: I have a need for help!!!" Previous message: R. Daniel Braun: "Re: I have a need for help!!!" In article "R. Daniel Braun" <rBraun@IUNET.IUPUI.EDU> writes: >Dr. Joe; >She is on oral Terbutaline. Would you send her home with her still doing >this ? >Dr. Bernstein; >I neglected to mention, we did already give Betamethasone when we did >the amniocentesis. We haven't done the CST yet. Do you have concerns >about what kind of contractions will be induced with oxytocin ? i.e. even >worse tetanic contractions than we already have. A couple of comments: 1. Why oral terbutaline, anyway? To my knowledge, it has never been proven to work for tocolysis. I do concede, however, that it may provide "telephone tocolysis" and may even have a significant placebo effect. If I were going to provide tocolysis for this patient (I wouldn't, given her story) then I would hit her with something that may work, like MgSO4 or SQ/IV terbutaline. If anybody is aware of data that supports oral terbutaline, please share it with me (seriously). I recently saw a class A1 diabetes patient on oral terbutaline at 34 weeks who was actually started on insulin by someone due to the glucose intolerance from terbutaline! This looks like a significant side-effect from an essentially unproven regimen. 2. How about an amniocentesis, and if mature, get the kid out via induction? Granted, while the strip is worrisome, it does not show repetitive lates, persistent brady or tachycardia, or flat variability, and as such one could argue that induction is not indicated. However, when I see a patient like this at term I am very reluctant to let her go home, and the ones who have had induction "always" seem to have significant decels in labor (anecdotal). 3. If induction not indicated, how about a CST to determine tolerance to repetitive labor contractions? (This may make the decision for you). Please let us know the outcome. Tough case. Ashley Hill D. Ashley Hill, M.D. Dept. of Ob/Gyn Florida Hospital Orlando, FL dahmd@gate.net Next message: Ira Mark Bernstein: "Re: I have a need for help!!!" Previous message: R. Daniel Braun: "Re: I have a need for help!!!"

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