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Re: New Series #1-Admission and NSVD of laboring patients From: John Robertson (jgmr@unixg.ubc.ca) Tue Dec 31 19:30:39 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: John Robertson: "Re: PAP Smear after TAH" Previous message: John Robertson: "Re: micronized oral progesterone" Maybe in reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients" ---------- > From: MBK80@aol.com > To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net> > Subject: New Series #1-Admission and NSVD of laboring patients > Date: Monday, December 30, 1996 10:17 PM > > 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 agree > Tests ordered- CBC -No more preps and enemas. U/A seems to be a waste of > money. The blood bank may accept a "tube to hold", without charge, to be > later used for a type and screen if needed. Of course this assumes routine > prenatal labs have been previously obtained (type rh, hbsag, rubella titer, > ab screen, sickle prep, hiv, rpr) > I agree > 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. > usually intermittent auscultation. I only monitor electrically (externally or internally) if the pregnancy is deemed to be high risk, or if something in the auscultation or inability to auscultate has me worried. > IV's- are they really necessary in many laboring patients??Just food for > thought for those of you still using them routinely.Obviously, we are not > discussing those patients with epidurals, PCA's etc., but even those patients > requesting IV analgesia may ask not to be "tied" to an IV. > No routine IVs in low risk pregnancies > Delivery- Remember that gases, and placental pathology are expensive. I know > of many that do these routinely. It is difficult to not be cost effective at > delivery.Its usually during labor that we consume so many expensive > resources. Most of us are using a standard delivery pack. Food for thought- > did you ever look to see how much of the pack you don't use. Do you use > drapes??? We don't and it really isn't necessary. Certainly many hospitals > require docs and midwifes to gown and use protective shields. This is for > each to decide on for safety. Getting the L/D area to customize the delivery > set up based on what members of the dept. use might be helpful to reduce > costs. > no routine cord gas. There is a drape pack. I kind of like the gown because blood leaking through your greens is kind of uncomfortable. > 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. > I agree J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C., Canada, V2P 3M9 (604) 793-9988 e-mail jgmr@unixg.ubc.ca The best we can do for one another is to exchange our thoughts freely; and that, after all, is about all. James A. Froude (1818-1894) Next message: John Robertson: "Re: PAP Smear after TAH" Previous message: John Robertson: "Re: micronized oral progesterone" Maybe in reply to: MBK80@aol.com: "New Series #1-Admission and NSVD of laboring patients"

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