BPP’s in patients on methadone

[Gas you down]

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So I’ve got an old coot of an OB who wants to section anything and everyone. 19 years old...that’s a C/S. He can’t even read a strip and he’ll say a patient’s having decels, when they aren’t. Dude really needs to retire.
Anyway, he sends a methadone pt over from his office b/c the BPP is a 6/10. Not great I agree, but many methadone pts have low BPP scores. She’s eating as she walks thru the door. At first he concedes it’s not an emergency. I say she’s gotta wait 8 hours. He flips out, now it’s a “semi emergency.” I’m firm. Then he says if somethings wrong with the baby it’s my fault. I go nuclear, tell him if it’s a real emergency get the chairman to call me.
Not a peep.
But still, I’m sitting here wondering if I’m setting myself up for a ****storm.
What does everyone else do in these methadone pts? Just put them on a monitor and wait for npo status? Do the case straight away?

 

[BLADEMDA]

I'd ask for 6 hours but would flex to 4 hours. Some of my partners may just do the case but typically the OB will give me a few hours to let the food digest on a patient who has just eaten.

As for the Methadone, I 'd recommend a TAP block for postop pain control or an Epidural with dilute local for the first 12-24 hours postop.

 

[coffeebythelake]

Wt

So I’ve got an old coot of an OB who wants to section anything and everyone. 19 years old...that’s a C/S. He can’t even read a strip and he’ll say a patient’s having decels, when they aren’t. Dude really needs to retire.
Anyway, he sends a methadone pt over from his office b/c the BPP is a 6/10. Not great I agree, but many methadone pts have low BPP scores. She’s eating as she walks thru the door. At first he concedes it’s not an emergency. I say she’s gotta wait 8 hours. He flips out, now it’s a “semi emergency.” I’m firm. Then he says if somethings wrong with the baby it’s my fault. I go nuclear, tell him if it’s a real emergency get the chairman to call me.
Not a peep.
But still, I’m sitting here wondering if I’m setting myself up for a ****storm.
What does everyone else do in these methadone pts? Just put them on a monitor and wait for npo status? Do the case straight away?

Wtf is a semi emergency

 

[BLADEMDA]

Wt


Wtf is a semi emergency

It's I have a golf game or dinner with my wife so the case needs to go soon.

 

[deleted126335]

I can’t even count the number of “emergency” C-sections that have been called in my career @ 5 am because the OB is finishing their shift @ 7am and wants to get it done by then. The other peak BS time is 5:30 pm. Right after office hours. Just as you think about sending the late guy home. The problem is that calling BS and making them wait, you will get away with it 99.99% of the time. But if anything goes wrong you will be left twisting in the wind for second guessing another specialist’s medical judgement.

 

[fakin' the funk]

So I’ve got an old coot of an OB who wants to section anything and everyone. 19 years old...that’s a C/S. He can’t even read a strip and he’ll say a patient’s having decels, when they aren’t. Dude really needs to retire.
Anyway, he sends a methadone pt over from his office b/c the BPP is a 6/10. Not great I agree, but many methadone pts have low BPP scores. She’s eating as she walks thru the door. At first he concedes it’s not an emergency. I say she’s gotta wait 8 hours. He flips out, now it’s a “semi emergency.” I’m firm. Then he says if somethings wrong with the baby it’s my fault. I go nuclear, tell him if it’s a real emergency get the chairman to call me.
Not a peep.
But still, I’m sitting here wondering if I’m setting myself up for a ****storm.
What does everyone else do in these methadone pts? Just put them on a monitor and wait for npo status? Do the case straight away?

Uh, no experience with methadone-using parturients. Definitely not on interpreting their BPPs or FHR strips.

Strictly speaking it's not our call whether something is an urgency, emergency, etc. If you trust the surgeon/proceduralist then their documentation of the optimal timing essentially determines the timing.

If you feel like the OBs decision making is suboptimal and that "we'll do it as an emergency if you document it as one" is inappropriate, get another OB involved.

 

[anbuitachi]

I can’t even count the number of “emergency” C-sections that have been called in my career @ 5 am because the OB is finishing their shift @ 7am and wants to get it done by then. The other peak BS time is 5:30 pm. Right after office hours. Just as you think about sending the late guy home. The problem is that calling BS and making them wait, you will get away with it 99.99% of the time. But if anything goes wrong you will be left twisting in the wind for second guessing another specialist’s medical judgement.

it's insane how many c sections there are these days. it's so easy for the OBs to say the C section is urgent or emergent.. i think their society needs to change their guidelines a bit cause all these sections are not improving care in our country compared to countries with lower section rates

 

[dannyboy1]

I don’t know how to read a bpp or a strip for that matter. If OB says the case needs to go, it needs to go. Why make things more difficult for yourself?

 

[nimbus]

it's insane how many c sections there are these days. it's so easy for the OBs to say the C section is urgent or emergent.. i think their society needs to change their guidelines a bit cause all these sections are not improving care in our country compared to countries with lower section rates

At least we are not Brazil. Many Brazilian women don’t even consider going through labor. It is outside their societal norm. It’s been that way at least since the 1990s.

These days what is considered good care and even the truth are all relative.

Why Most Brazilian Women Get C-Sections

 

[dhb]

At least we are not Brazil. Many Brazilian women don’t even consider going through labor. It is outside their societal norm. It’s been that way at least since the 1990s.

These days what is considered good care and even the truth are all relative.

Why Most Brazilian Women Get C-Sections

That article is trash. I did a 3 month OB rotation in Brazil and saw many more vaginal deliveries than c-sections.

Now maybe in private clinics they push the envelope for convenience, but let's face it: the high c-section rate is driven by the desire to keep it fresh down there.

 

[nimbus]

That article is trash. I did a 3 month OB rotation in Brazil and saw many more vaginal deliveries than c-sections.

Now maybe in private clinics they push the envelope for convenience, but let's face it: the high c-section rate is driven by the desire to keep it fresh down there.

It depends on the setting. Overall the csection rate is 56%.

Brazil Tries to Cut High Rate of C-Section Births

 

[leaverus]

Uh, no experience with methadone-using parturients. Definitely not on interpreting their BPPs or FHR strips.

Strictly speaking it's not our call whether something is an urgency, emergency, etc. If you trust the surgeon/proceduralist then their documentation of the optimal timing essentially determines the timing.

If you feel like the OBs decision making is suboptimal and that "we'll do it as an emergency if you document it as one" is inappropriate, get another OB involved.

Agree. And I consider all OB patients full-stomach whether they've just eaten or I've made them wait the 8hrs

 

[deleted162650]

C-section in Brazil = Vaginal Preservation Surgery