Re: 34 week prom
From: Efrain Ramirez (eramirezt@coqui.net)
Sat Apr 9 13:40:23 2005
Muy bien!
>At Sat, 9 Apr 2005, 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
>
--
I think I will do nothing for a long time but listen,
And accrue what I hear into myself...and let sounds
contribute toward me.
~walt whitman~
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