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Re: A caseFrom: Larry Glazerman (glazerman@enter.net)Mon Dec 2 17:48:32 1996
>17 y/o, primigravida, 41 3/7 wks, adequate prenatal care, came to the >hospital claiming 3 days of absent fetal movements. She had only slight >irregular uterine contractions, no history of watery discharge. Her >examination revealed: FH 35 cm, elevated uterine tone, FHR 152 bpm on >Doppler, with desaccelerations (down to 60 bpm). Upon admission, a NST was >reactive, adequate variability, showing some cord compression pattern, but >without any real desacceleration on a 30-minute recording. The US revealed >severe oligohydramnios (AFI = 2.0), BPP=4/6. EFW = 3600 g. >Her cervical conditions were 3 cm dilated, 70% effaced. Vertex, station - >2, intact membranes. The pelvis was clinically assessed as adequate for >vaginal delivery. > >Question: Is amnioinfusion + labor induction absolutely indicated in this >setting? Why or why not? > >Thanks for your opinions. > >Sing-Hung Chang, MD >Resident This patient absolutely needs to be delivered. At 41+ weeks with oligohydramnios and decels down to 60, there is no percentage in waiting. Given her cervical status,. I would start pitocin, rupture membranes when the head is engaged, and decide on amnioinfusion as the situation warrants
-- Larry R. Glazerman, M.D. FACOG Valley Ob-Gyn Associates Allentown PA
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