Re: 34 week prom
From: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net)
Fri Apr 8 17:51:39 2005
I do the following:
-Delivery at 34 weeks if they remain latent that long.
-I.V. antibiotics for 48 hours following admission, followed by switching to
an oral antibiotic regimen of erythromycin and amoxicillin (so called
"Mercer protocol"), which has been shown to increase the latent period in
PPROM prior to the onset of labor.
-Betamethasone up to 34 weeks, if there is no clinical evidence of
infection.
-20 minute fetal monitor twice daily.
-Once weekly BPP's.
-Every two-three week interval growth assessment.
-Hospital bedrest.
Lynn
--
Lynn D. Montgomery, M.D.
Maternal-Fetal Medicine, OB/GYN
Rocky Mountain Women's Health
2835 Fort Missoula Rd., Suite 304
Missoula, Montana, 59804
406-549-0978
fax 406-549-0987
e-mail: apgar10@montanadsl.net
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew
Folley
Sent: Friday, April 08, 2005 2:57 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: 34 week prom
Lynn thanks for such a clear anc concise response. Over the past yar I have
been pushing for giving steroids antibiotics and tocolysis for PPROM at
32-34 weeks and cytokine release etc and role in causing cerebral palsy. Do
you think that is too aggressive at this point??? andy
>From: "Lynn D. Montgomery, M.D." <apgar10@montanadsl.net>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: RE: 34 week prom Date: Fri, 8 Apr 2005 14:04:10 -0500
>
>This issue has been addressed with several abstracts over the past two
>years at the Society meeting. Because of the increased incidence of
>neurodevelopmental issues associated with children who are products of
>PPROM over controls with just prematurity, the effects of various
>inflammatory markers (i.e. cytokines, metalloproteinase's,
>interlukins)have been looked at. Granted, some of these studies are
>animal models, but exposure of brain tissue to these substances has
>impressive effects. Because these factors are produced prior to
>clinical evidence of infection, and thus the potential untoward effects
>on the fetus, it has been suggested to move the point at which you
>electively deliver, with PPROM, earlier that what I was taught at
>36 weeks. Data is pretty conclusive that 34 weeks is the more prudent
>timing - issues regarding prematurity are outweighed by the risk of
>neurodevelopmental issues - and the fact that the ultimate outcome of
>pregnancies beyond 34 weeks is the same. One paper actually goes as
>far as suggesting that 32 weeks is the more prudent "end-point" in
>PPROM. I haven't yet been convinced to go that far.
>
>A year ago at the Society meeting, because of what these various papers
>suggested, I polled several programs represented, asking them what
>their policy was with regard to timing of delivery with PPROM and the
>predominate answer was 34 weeks.
>Lynn
>
>Lynn D. Montgomery, M.D.
>Maternal-Fetal Medicine, OB/GYN
>Rocky Mountain Women's Health
>2835 Fort Missoula Rd., Suite 304
>Missoula, Montana, 59804
>406-549-0978
>fax 406-549-0987
>e-mail: apgar10@montanadsl.net
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>Andrew Folley
>Sent: Thursday, April 07, 2005 10:16 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: RE: 34 week prom
>
>Question: Had a patient show up last night G3P2 ruptured membranes 34
>weeks
>1 day. 2 prior c-sections. Not in Labor. What to do? She is vertex
>fluid in vault sent for f-pole showed not mature. My plan was
>steroids, tocolysis for 48 hours if necessary and repeat c-section in
>48 hours.
>Along with GBS prophylaxis. Some of our MFMs were not so happy with
>the management plan. What ywoud you do???? andy
>
> >
>
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