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Re: New Series #1-Admission and NSVD of laboring patients From: Geffrey H. Klein, MD (gklein@bcm.tmc.edu) Tue Dec 31 17:39:17 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: David A. Nagey, MD, PhD, PE, FACOG: "Re: An Alaska Guy's 12 Days of Christmas" Previous message: Robert Brenner: "Re: Routine Sonograms ?" In reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients" Next in thread: John Robertson: "Re: New Series #1-Admission and NSVD of laboring patients" >1-Admission- Admission should be ordered when patients are in active labor. >Admission in the latent phase (<3cm) may result in prolonged labor, >unnecessary invasive procedures, higher c/s rates, and greater expense. > 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. I >dont want to get into a discussion here regarding this issue, the main point >is that just because PROM has occured, admission does not have to be >automatic. Our experience is quite favorable with conservative management >when appropriate with resultant lower cost and no increase in morbidity. Yes, >the B strep issue is a concern. I have to disagree with not admitting and inducing PROM. The NEJM TERMPROM study showed no increase in C/S rate, a lower infection rate, and greater patient satisfaction with immediate induction vs. expectant management. >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. I think >we are all familiar with the literature on monitoring . Remember that >internal monitors are very expensive. I think a nurse to do 1 on 1 nursing is more expensive than continuous monitoring.. >Delivery- Remember that gases, and placental pathology are expensive. I rarely send these and agree they are a waste and almost never contribute anything to the uncomplicated delivery.. >Post Partum- we dont do any labs unless a PPH is incurred. Analgesia per >patient request but certainly not a need for epidural narcotics. 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. Discharge home any time after 8 >hours with good home support in a motivated, educated patient, to 24-48 >hours based on individual needs. For the most part we find our patients >wanting to leave after a 1 night stay. Many docs keep their patientsd 2 days >by routine , and this is expensive.We do many circumcisions in the office due >to scheduling and working around the pedi visit. These are all good thoughts on cost-cutting. Most of my patients don't want to stay 48 hrs.. -- Geffrey H. Klein, MD listowner: OB-GYN-L Advisory Board Chairman, OBGYN.net < http://www.obgyn.net > gklein@bcm.tmc.edu gklein@icsi.net http://www.bcm.tmc.edu/obgyn/obgyn-ce/geff.html 6800 W. Loop South #520 Bellaire, Texas 77401 (713) 664 8900 Next message: David A. Nagey, MD, PhD, PE, FACOG: "Re: An Alaska Guy's 12 Days of Christmas" Previous message: Robert Brenner: "Re: Routine Sonograms ?" In reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients" Next in thread: John Robertson: "Re: New Series #1-Admission and NSVD of laboring patients"

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