Re: 34 week prom
From: Robert J. Carpenter, Jr. MD (zygote@icsi.net)
Sat Apr 9 12:27:39 2005
AMEN!
On 9 Apr 2005 at 11:46, Garry E. Siegel, M.D. wrote:
> Unencumberd with any academic experience or data, I would give
> steroids to virtually anyone under 34 weeks unless delivery was
> obviously imminent.
>
> Unless I missed something, steroids are about the only thing that we
> do that makes a difference, and our goal should be getting them on
> board and holding people off for 48 hours. After that, treatment of
> PTL is done, but probably makes no difference in ultimate outcome.
>
> I don't try to inhibit if ROM after 34 weeks; maybe I would at 32 to
> 34, depending. In general, if you're ruptured and laboring, you are
> unstoppable and there may be a reason you're in labor!
>
> If 34 and ROM, allow labor, but probably would manage expectantly for
> a few days. The situation will declare itself.
>
> If 35 and ROM, probably would induce.
>
> For PTL and intact membranes, I have less and less enthusiasm for
> attempting labor inhibition after 34 weeks, and I don't do it after
> 35.
>
> Sorry for the long answer to your short question.
>
> Garry
>
> At Sat, 9 Apr 2005, 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
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
Robert J. Carpenter, Jr. MD
6624 Fannin, #2720
St. Luke's Medical Tower
Houston,TX 77030-2339
713-795-4600
