Re: 34 week prom
From: R. Daniel Braun (rd.braun@gmail.com)
Sat Apr 9 10:55:22 2005
Lynn,
Is the science for this really there? Or is it like so many other
things that we do, HUAM & Tocolytics for examle, that we do because
even though the science isn't there, we think it makes sense and it
ought to work. IOW, is there an RCT? I don't see any way to blind it,
certainly an RCT, could be done to answer the question. From your
discussion, I got the idea that the only studies were observational
and some of them were in animals.
Dan
On Apr 8, 2005 9:55 PM, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote:
> 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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> >>
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>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
R. Daniel Braun
Kinky for Governor
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