Re: pprom and antibiotics
From: Peter Wein (pwein@unimelb.edu.au)
Tue Aug 9 23:17:39 2005
If increased latency does not improve outcome, it does not have any benefit
of itself - this was shown in the amoxiclav arm of ORACLE, where there was
increased latency but worse outcome if anything with antibiotic. CRP is
almost valueless.
Peter
>----- Original Message -----
From: "Garry E. Siegel, M.D." <garrys@mindspring.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Wednesday, August 10, 2005 4:20 AM
Subject: Re: pprom and antibiotics
> 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
>>may contain information that is privileged or exempt from disclosure under
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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
>>>>> intended recipient(s), you are notified that the dissemination,
>>>>> distribution or copying of the messages is strictly prohibited. If
>>>>> you receive this message in error, or are not the named
>>>>> recipient(s), please notify the sender at either the e-mail address
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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
>>>>> recipient(s) and may contain information that is privileged or
>>>>> exempt from disclosure under applicable law. If you are not the
>>>>> intended recipient(s), you are notified that the dissemination,
>>>>> distribution or copying of the messages is strictly prohibited. If
>>>>> you receive this message in error, or are not the named
>>>>> recipient(s), please notify the sender at either the e-mail address
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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
