Re: 32 week PROM Recent Herpes outbreak Help
From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)
Mon Jan 17 16:18:03 2005
Well, I always play the testimony game: what am I going to say to the
attorney representing the patient if I get sued:
"So, Doctor. Your MFM consult recommended immediate c-section and you chose
to wait, and the baby developed herpetic encephalitis. What where you
thinking of, with your general training background?"
I suppose that in this case since they are the expert consultants I would
follow their advice. You did ask for their advice despite the fact that you
might have received expectant management advice from another MFM.
--
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew
Sent: Monday, January 17, 2005 4:56 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: 32 week PROM Recent Herpes outbreak Help
At Mon, 17 Jan 2005, art fougner, md wrote:
>No prodromal symptoms. I agree and that was my plan of action as well.
MFMs recommended primary section due to "risk of herpes shedding" and
potential for herpes encephalitis.
>Any prodrome?
>
>art
>
>At Mon, 17 Jan 2005, Efrain Ramirez wrote:
>>
>>Agree with Richard - antibiotics, Valtex, steroids/tocolytics - for 48
>>hours -- wait- reevaluate..
>>
>>> At Mon, 17 Jan 2005, Richard Chudacoff, MD wrote:
>>>
>>>Interesting cases you have. No current outbreak, I'd place her on
>>>prophylactic Valtrex, treat with antibiotics for a week and steroids for
48
>>>ours. I'd like to get 48 hours of out her, but if cultures come back
>>>negative, then I'd wait until she tips her hand
>>>
>>>--
>>>Richard Chudacoff, MD
>>>
>>>-----Original Message-----
>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew
>>>Sent: Monday, January 17, 2005 8:19 AM
>>>To: Multiple recipients of list OB-GYN-L
>>>Subject: 32 week PROM Recent Herpes outbreak Help
>>>
>>>Please give me your thoughs on the following: 32 week 5 day G1P0 comes
>>>in with PROM. Recurrent herpes outbreak on vulva treated two weeks agow
>>>with PO valtrex. No prodromal symptoms or active lesions now. Cx 1 cm
>>>25%. Do you go to primary section for recent herpes outbreak?? Do you
>>>give steroids and wait 48 hours and induce? Give IV Valtrex and no
>>>steroids and wait? Any role for HSV titers or culture?
>>>
>>--
>>"The opposite of a correct statement is a false statement.
>>But the opposite of a profound truth may well be another profound truth."
>>
>>Niels Bohr (1885 - 1962)
>>
>--
>art fougner, md
>
> "If you don't know where you are going, you will wind up somewhere else."
>Lawrence Peter Berra
>
