-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: New Series #1-Admission and NSVD of laboring patients From: KELLY SHANAHAN (mks@sierra.net) Tue Dec 31 15:57:40 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Robert J Woolley: "Re: PAP Smear after TAH" Previous message: Robert J Woolley: "Re: PAP Smear after TAH" Maybe in reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients" Next in thread: Garry E. Siegel: "Re: New Series #1-Admission and NSVD of laboring patients" >1-Admission- Admission should be ordered when patients are in active labor. Agree. Sometimes in this mountain community I have to admit a patient earlier because she lives on the other side of the pass or because it's snowing, etc. > Admission of the patient with PROM at term may be deferred until the patient >goes into spontaneous labor (many clinicians will prefer to have a reactive >nst prior to allowing this patient to go home to await the onset of labor. Agree. I send the patient to the hospital for an NST and if it's reactive OFFER her the option of going home (actually I encourage that, but let her decide based on her confort level, where she lives ...). If spontaneous labor does not ensue with in 12-24 hours (depends on the time of rupture -- my nurses will kill me if I start an induction at 2AM :-) ), she comes in for induction. I follow recent ACOG guidelines, using the risk model, for Group B Strep. >Tests ordered- I must be pretty young because I've NEVER even seen anyone order a vag prep or an enema! At our hospital we get a CBC and a "hold clot" for possible T&S. > >Monitors- as you deem necessary- Many hospitals now are on a case rate and >monitoring does not cost more, however, remember it "costs" the hospital to >use a monitor , for its monitor paper, fileing, nurse observers, etc. Agree. Good point about the costs of monitoring: I've never really thought about it, but you're right. > >IV's- As someone else has mentioned, placing a saline lock is a reasonable middle ground. > >Delivery- Remember that gases, and placental pathology are expensive. Don't send them routinely. >did you ever look to see how much of the pack you don't use. More good food for thought. Maybe I should just have the nurses open one of the emergency delivery basins and a gown & glove -- that's about all I use. > >Post Partum- we dont do any labs unless a PPH is incurred.... We have >found many of the typical epifoams, proctocreme and stool softeners are not >necessary. We stopped using them a few years ago. Liberal use of ice packs >and sitz baths after 24 hours works nicely.... For the most part we find our patients >wanting to leave after a 1 night stay. We're still getting a postpartum H&H but I agree that it's pretty useless unless there has been a bleed. Maybe our little hospital should conduct a survey of our patients to see if they found any benefit to all the foams and creams and stuff we give them. Most of our moms go home after 24 hrs -- have you noticed it's almost always the multips that want to stay longer? Thanks, this is a great idea. -- Kelly Shanahan, MD S. Lake Tahoe small 80 bed hospital (licensed, not actual!) with 600 deliveries/year Next message: Robert J Woolley: "Re: PAP Smear after TAH" Previous message: Robert J Woolley: "Re: PAP Smear after TAH" Maybe in reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients" Next in thread: Garry E. Siegel: "Re: New Series #1-Admission and NSVD of laboring patients"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:20:21 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.