Re: OB: Preeclampsia?
From: Andrew Folley (agfolley@hotmail.com)
Tue Sep 27 12:25:07 2005
Garry
Yes she does have preeclampsia and it is mild at this time based on
proteinuria over 300 grams and BP. No evidence of HELLP syndrome form labs.
She is going to deteriorate over the next two weeks. Keep in hospital
until sectioned. Ideally deliver after 34 weeks but not beyond 36 weeks.
Doppler studies on babies twice a week. 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: OB: Preeclampsia?
>Date: Mon, 26 Sep 2005 21:27:04 -0500
>
>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
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