Re: pprom and antibiotics
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Aug 9 13:20:06 2005
My sentiments exactly, given the immature FLM, and stated much better by
a better authority.
Garry
At Tue, 9 Aug 2005, Lynn D. Montgomery, M.D. wrote:
>
>In this case, the unique circumstance of a gastroschisis complicates the
>case. The pediatric anesthesiologist and pediatric surgeon will appreciate
>only having to deal with one problem (gastroschisis), rather than two
>(gastroschisis + respiratory). Normally, when I get a baby with PPROM to 34
>weeks, I deliver, regardless of information regarding lung maturity - the
>reason being the infectious risk, etc. In this case, especially with the
>information regarding immature lungs, I would use expectant management and
>periodically check the vaginal vault fluid for maturity. I would deliver
>for even the slightest indication of brewing infection (i.e. uterine
>irritability, tenderness, fever, bands on WBC or rise in CRP). Regardless
>of the strep status, I treat patients that I am expectantly managing with
>PPROM based on the studies showing an increase latency between rupture and
>onset of labor in those treated with antibiotics.
>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 Richard
>Chudacoff, MD
>Sent: Tuesday, August 09, 2005 7:35 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: pprom and antibiotics
>
>Okay, but her fetal lung maturity test came back immature. Now what would
>y'all do? Still afebrile, negative c-reactive protein, normal WBC,
>non-tender and acontractile.
>
>Richard Chudacoff, MD
>
>This message is confidential, intended only for the named recipient(s) and
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>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
>Ramirez
>Sent: Monday, August 08, 2005 6:46 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: pprom and antibiotics
>
>Give her another anitibiotic - whatever - and deliver...
>
>>At Mon, 8 Aug 2005, Garry E. Siegel, M.D. wrote:
>>
>>Agree with prompt delivery. If you had it to do all over again:
>>
>>1. Culture for GBS upon admission if no result known.
>>2. Cover with PCN for GBS.
>>3. Deliver since 35 or more.
>>
>>The gastroschisis doesn't alter management.
>>
>>My understanding is that the latency is increased with Amp/Erythromycin.
>>That is not needed here.
>>
>>Now, if you're already on Amp/Erythromycin, and she can't tolerate the
>>Erythromycin, dropall antibiotics since GBS negative and deliver.
>>
>>Garry
>>
>>At Mon, 8 Aug 2005, Charlie Chambers wrote:
>>>
>>>Not necessarily. I figure that at 36 weeks this kid has a low chance
>>>of RDS. What's the odds of chorio with PPROM or cord accident in the
>>>next week? Worst case scenario, I guess I'd rather have a kid with
>>>gastroschisis and at worst mild RDS, vs. gastroschisis wtih chorio or
>>>cord compromise.
>>>
>>>On Aug 8, 2005, at 11:23 AM, Richard Chudacoff, MD wrote:
>>>
>>>> Would fetal gastroschisis change your management with PPROM?
>>>>
>>>>
>>>> Richard Chudacoff, MD
>>>>
>>>>
>>>> <unknown.jpg>This message is confidential, intended only for the
>>>> named
>>>> recipient(s) and may contain information that is privileged or
>>>> exempt from disclosure under applicable law. If you are not the
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>>>>
>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>> rmodugno@aol.com
>>>> Sent: Monday, August 08, 2005 1:17 PM
>>>> To: Multiple recipients of list OB-GYN-L
>>>> Subject: Re: pprom and antibiotics
>>>>
>>>> Not sure why you're not delivering this patient with pprom at 36
>>>> weeks.
>>>>
>>>> Robert Modugno MD MBA FACOG
>>>> Marietta, GA
>>>>
>>>>
>>>>
>>>> -----Original Message-----
>>>> From: Richard Chudacoff, MD <rchudacoff@mylinuxisp.com>
>>>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>> Sent: Mon, 8 Aug 2005 10:29:53 -0500
>>>> Subject: pprom and antibiotics
>>>>
>>>> I have a question, which Bob Carpenter and I have discussed, but I
>>>> wanted the groups opinion.
>>>>
>>>> 18 yo G1 at 35 weeks, PPROM. Started on Amp and Erythromycin
>>>> prophylactically, but could not tolerate the Erythro, so this was
>>>> stopped. GBS came back negative. Patient is now 36 weeks. My
>>>> question is, in the face of data that shows in increase in
>>>> resistance and necrotizing enterocolitis with ampicillin, Unasyn or
>>>> Augmentin without erythromycin, would you continue the ampicillin?
>>>> Now, let?s add the fact that the baby has gastroschisis?what would
>>>> your antibiotic option be?
>>>>
>>>> Richard Chudacoff, MD, FACOG
>>>>
>>>> Women's Specialists of Houston
>>>> 6624 Fannin Suite 1800
>>>>
>>>> Houston, TX, 77030
>>>>
>>>> 713-797-1144
>>>> 713-425-3071
>>>>
>>>> Email: Richard.Chudacoff@obgyn.net
>>>> rchudacoff.md@womenspecialists.com
>>>>
>>>> [Image removed]
>>>> This message is confidential, intended only for the named
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>>>> exempt from disclosure under applicable law. If you are not the
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>>>> you receive this message in error, or are not the named
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>>>>
>>>>
>>>**********************************************************************
>>>**
>>>**********************************************************************
>>>****
>>>**********************************************************************
>>>**
>>>**********************************************************************
>>>**********************************************************************
>>>**
>>>
>>>--
>>>Charlie Chambers
>>>Hood River, OR USA
>>>cchamber@alumni.rice.edu
>>>
>>>"...not because I regard fishing as being so terribly important but
>>>because I suspect that so many of the other concerns of men are
>>>equally unimportant-and not nearly so much fun."
>>> John Voelker
>>>**********************************************************************
>>>**
>>>**********************************************************************
>>>*****
>>>**********************************************************************
>>>**
>>>**********************************************************************
>>>**********************************************************************
>>>**
>>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>"Character may be manifested in the great moments, but it is made in the
>small ones."
>
> - Phillip Brooks
>
> ~walt whitman~
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
