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Bad hx patient- addendumFrom: Joshua Copel (joshua.copel@yale.edu)Mon Jun 24 06:43:24 1996
Subject: Time: 2:35 PM OFFICE MEMO Bad hx patient- addendum Date: 6/19/96 Listers- this is a repost with an addendum of a case presented last week for comments- We have a G4P3LC2 at 37 weeks. First baby was IUGR/IUFD at term. 2 and 3 were NSVD without comp. Current pregnancy had oligo diagnosed at approx 34 weeks. AFI ranges from 3-8. Currently 8. Followed conservatively with lots of testing. L/S 4.4 with + band in PG region. EFW 2400g @ 37 weeks. Just finished day 3 of induction. Has had PG gel X2, laminariaX1, and pit X3. Cervix remains 1/long/very posterior /-3/-2. No change x weeks. Technically possible to AROM, but we are not convinced it is the thing to do. Do not want to commit mom to c/s at this point. FH has been great except for variable decel last nite x 2- 3 minutes. Have suggested misoprostol for tonight (not an established practice at our hospital). If not in labor or inducable after 12 hours (or so) of misoprostol, what would you do? (We are currently leaning to leaving her alone, monitoring in hospital, and just waiting.) Elisabeth Hyde CNM Branford, CT Addendum to original post: The patient has been seen by MFM (me specifically), and based on the AFI in the low normal range we suggested outpatient testing until cervix ripe. I think the oligo originally may have been due to mild dehydration during a recent heat wave here. Betsy is correct, misoprostil is not "established practice" here, but we did get it through our formulary last week. This is the third patient to get it here. Got two doses & contracted without cervical change. Whole scene is complicated by high patient anxiety. In response to queries on fetal status, we do not have computerized CTG available. Doppler of umbilical artery is normal & EFW is 25-30%ile for age. Biophysical profile shows breathing, movement & tone. Please note: I wrote this last week before the list server went haywire & do not know if anyone received it. I am posting again Monday morning BEFORE I go to L&D to see how things turned out over the weekend. Josh Copel Yale Ob-Gyn, MFM Joshua.Copel@Yale.edu
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