me: ob on call, up with a patient in active labor--she will deliver about an hour later
CNM: recently graduated midwife, new in our practice, not afraid to ask questions.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CNM: my patient has been on Pitocin [intravenous medicine which initiates or increases labor contractions] for 12 hours now, and she is unchanged at 3cm. What should I do?
me: did she get Cytotec [misoprosto--another medicine to induce contractions]? Or the Cook catheter [a plastic balloon inflated inside cervical canal to promote cervical dilating]?
CNM: three doses, each 25 mcg; I tried to place a Cook catheter, but couldn't do it; never failed before and I've done a lot
me: that's a small Cytotec dose, why not [the usual] 50?
CNM: That's what Kris did [the previous CNM]; I don't know--I'm new here.
me: Well, Kris is wimpy, if she didn't come in contracting, start with 50. If she were to present with irregular contractions, you might want start with 25 and then increase to 50 with second dose. But here, I'd have given her 50 from the beginning. Have you considered another attempt to place the Cook catheter?.
CNM: maybe stop everything, let her sleep and start all over in the morning?
me: what difference is a few hours going to make? Why not just sent her home?
CNM: we're inducing her for gestational hypertension
me: what's her blood pressure now and what was her blood pressure at her first clinic visit?
[pause while records are being searched]
CNM, 126/84 now, 124/82 at first visit
me: doesn't sound like gestational hypertension to me; that was just stuck in to justify an induction for a patient that you didn't want to send home. I'd try the Cook catheter again, while continuing increasing the pitocin.
[Cook catheter not attempted; pitocin continued: vaginal delivery around noon]
Sunday, June 12, 2016
Subscribe to:
Post Comments (Atom)
Ooh, a lot of these terms were used a few months ago when I was in my friend's delivery room. She was a couple days over her due date so they induced, partially because she was group b strep positive and they wanted to have time to get the antibiotics in. I ended up going home and she slept all night and then they started everything up again in the morning - I think including the cook catheter... and her baby wasn't born until the following evening. And meanwhile I still haven't seen a baby born!
ReplyDelete