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Re: Management of labile patients in labourFrom: Bernard Cristalli (bcrist@club-internet.fr)Mon Aug 18 13:55:29 1997
John G. M. Robertson MD wrote: > > Question for the group: What do you do with patients that are "out of > control" when they are in labour > > Background: > 23 yo Muslim Pakistani lady in her second pregnancy at term with > spontaneous onset of labour. 1st pregancy ended in C/S for breech at term > (another OBGYN - not all details available but transverse uterine > incision) Seen by a second OBGYN in this pregnancy and decided for a > VBAC. Other OBGYN is aeay this weekend and patient presents in active > labour. No abnormalities obvious in labour apart from screaming with each > contraction typically only heard at or near crowning. At one point nurse > asks if the pain occurs between contractions as well, half an hour later > patient says pain is present all the time. Reassessment at that time > shows good FHR pattern, normal abdominal exam (no suggestion of > dehiscence) and cervix 4-5 cm dilated. Patient is recieving demerol 50 - > 100 Q2H and liberally using entenox. Patient has also struck an LDR nurse > once (nurse handled it appropriately and patient was told that that was > not appropriate behaviour). Bottom line is that I find it very difficult > to assess the patient re concerns of uterine rupture, adequate analgesia, > etc. How do other people approach these sorts of patients? > -- We've got a lot of muslims & "african africans" like you would say in "politically correct". It's a very frequent way of giving birth, and a cultural way too. You've got two ways of doing 1. leaving her alone, screaming 2. trying to have an epidural.-- Bernard Cristalli MD CNGOF AIHP - ACCA Paris - France http://www.obgyn.net/corresp/cristalli.htm
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