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A case-reply from MG ( UK ) From: Malcolm Griffiths (Malcolm@mgriff22.demon.co.uk) Wed Dec 4 18:13:29 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Allen Gardner: "Re: Raised FSH level and Down's risk" Previous message: George M. Grunert: "McDonald stitches" In reply to: Sing-Hung Chang: "A case" Next in thread: Ana C. Cunha: "Re: A case" In message <199612011953.TAA14877@cariari.ucr.ac.cr>, Sing-Hung Chang <changl@cariari.ucr.ac.cr> writes >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? > UK experience of amnioinfusion is not positive, but I appreciate others experience is better. At this gestation I would be thinking about induction anyway. However I would be almost expecting the CTG to get worse leading me to ( ? inevitably ? ) CS. I certainly wouldn't sit on her ! My assumption would be either oligohydramnios due to SROM or feto-placental problems - neither being good news !! It may be that someone will say that amnio-infusion will avoid the cord compression that will lead me to diagnose fetal distress, thereby avoiding a CS. -- Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) 01525-222849 (home) Fax: 01582-497424 email: Malcolm@mgriff22.demon.co.uk "It is dangerous to be right on a subject on which the established authorities are wrong." (Voltaire) Next message: Allen Gardner: "Re: Raised FSH level and Down's risk" Previous message: George M. Grunert: "McDonald stitches" In reply to: Sing-Hung Chang: "A case" Next in thread: Ana C. Cunha: "Re: A case"

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