Re: 34 week prom
From: Robert J. Carpenter, Jr. MD (zygote@icsi.net)
Sat Apr 9 12:24:40 2005
I am unaware of any prospective controlled study after 32 weeks. The original
liggins-Howie data did not go that far and most other studeis have nopt done som
since it would take a substantial number oif patients in each cell. I single dose of
Celestone will not harm child and if you believe it is appropriate then give it.
Challenge them to show you data that it is not effective.
I have used it in the past and will use in the future in that situation. Bob
On 9 Apr 2005 at 11:15, Andrew Folley wrote:
> Garry, what do you think of steroids for prom at 32-34 weeks. Our
> MFMs are saying no benefit shown after 32. I know I have read studies
> of giving steroids at 32 to 34 and then delivering 48 hours later.
> andy
>
> >From: garrys@mindspring.com (Garry E. Siegel, M.D.)
> >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 21:55:34 -0500
> >
> >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
>
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Robert J. Carpenter, Jr. MD
6624 Fannin, #2720
St. Luke's Medical Tower
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