Re: 34 week prom
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri Apr 8 21:52:55 2005
ROM at 34 or more--expectant management or deliver.
No steroids over 34 weeks.
Garry
At Fri, 08 Apr 2005, Andrew Folley wrote:
>
>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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Garry E. Siegel, M.D.
Private Practice
Roswell, GA
