Re: OB: Preeclampsia?
From: art fougner, md (evsono@pipeline.com)
Tue Sep 27 08:36:18 2005
Garry
You have 3 potential causes for RUQ pain ... stones, hydroneph and
Toxemia ... clinically she seems stable. Are her labs similarly
stable?
Art
At Mon, 26 Sep 2005, Garry E. Siegel, M.D. wrote:
>
>22 YO P0 at 30w4d calls Saturday PM
>
>Known twin pregnancy, later (16 weeks) and somewhat haphazard prenatal
>care.
>
>She called with RUQ/rib pain, and her smart obstetrician (initials GES)
>attributed it to musculoskeletal pain. She called an hour later and
>said her mother checked her BP--150/100. The same smart Ob said, come
>on in.
>
>Due to car trouble, she went to a closer to home hospital with no Ob
>services, and the ER doc called--BP 150/100, gave her morphine/phenergan
>for the pain, and got labs. WBC 18K, Hct 29, platelets 370K, SGOT
>normal, creatinine "normal" at 1.0. U/A negative protein, other stuff.
>
>I said, please start Mag, give her hydralazine (she was now 155/105) and
>send her over.
>
>My evaluation:
>
>BP 120 to 150/80's, no symptoms except RUQ/rib/upper flank pain. With
>questioning, she has had indigestion for a while.
>
>Exam unremarkable, cervix 1.5/25, breech. Brief U/S--breech/transverse.
>
>NST Non-reactive, spont. CST negative.
>
>BTW, was treated for a UTI this week found on routine urinalysis.
>
>So. . .Sunday AM, 30w5d
>
>24 hour urine begun
>Steroids given
>MFM BPP 8/8 for both, but twin B is 24% with a 5th percentile abdomen
>Mag cut to 1 gram/hour, and levels still 5.9
>
>Chart reviewed: spotty pre-natal care begun at 16 weeks; Urine C and S
>from mid 8-2005 10 to 25K E. coli--that is what she was treated for.
>WBC in June and August both around 18K, never addressed.
>
>Today, 30w6d:
>
>MFM suggests renal ultrasound--mild right hydronephosis, gallstones
>without inflammation/wall thickening
>
>AM Mag 6.0--cut to 3/4 gram/hour
>SGOT 30--on the upper edge of the normal range
>Platelets the same, Hct. 26 or so
>
>24 hour Creat. clearance 96 ml/minute, 439 mg. protein/24 hours. Serum
>creatinine 1.2, repeat SGOT in PM 32. Mag 6.0, cut to 1/2 gram/hour.
>
>Does she have pre-eclamsia?
>Would you call it severe?
>Would you deliver? When?
>Do you think the ultrasound findings--gallstones, right hydro--have any
>relationship to her symptoms and findings?
>
>Garry
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
