Re: 23 weeks prom
From: D. Ashley Hill (dahmd@cfl.rr.com)
Mon Feb 19 17:38:18 2007
Agree there is more than one way to manage this unfortunate situation.
Generally, here is our our team would handle this:
1. Evaluate for chorioamnionitis, obtain cervical and vaginal cultures
via sterile speculum exam, obtain neonatology and MFM consultation,
discuss what to do if delivery occurs in next week (resuscitate vs not)
and avoid digital exams.
2. IV ampicillin and erythromycin for 48 hours then, if labor not
imminent and cultures negative, discontinue. If GBS positive, switch to
oral amoxicillin and erythromycin for 5 more days.
3. Steroids at 24 weeks (I don't have a problem giving them at 23
weeks. The question is whether patient should get a 2nd course after 24
weeks).
4. Admit to high-risk unit until indication for delivery or 34 weeks.
If vertex at 34 weeks, induction. If prior uterine scar or if
non-vertex or nonreassuring status at 34 weeks, then cesarean.
5. Sonography every month for growth. Fetal monitoring per unit
protocol, unless otherwise indicated.
Ashley
At Sun, 18 Feb 2007, Andrew Folley wrote:
>
>G1P0 23 wk 1 day prom Would you give antibiotics? Which one(s) IV or PO
>and how long 3, 5, 7 days etc. Keep in hospital how long?? 72 hrs 1
>week, 2 weeks?? Until 34 weeks? Give steroids now or wait till 24 weeks?
>I do not think there is any "right" evidence based answers on this. Just
>looking to get a feel for what we are all doing. andy
>
>>From: eramirezt@coqui.net (Efrain Ramirez)
>>Reply-To: ob-gyn-l@obgyn.net
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: Re: mirena and irregular bleeding
>>Date: Sun, 18 Feb 2007 00:34:28 -0600
>>
>>Oc's, Ponstel, do Gc/Chlamydia cultures.. can use as, Andy says,
>>Premarin..but I prefer Oc's
>>
>>Ef
>>
>>At Sat, 17 Feb 2007, Andrew Folley wrote:
>> >
>> >possibly atrophic, consider 6 weeks of unopposed estrogen (ie premarin
>> >0.625) see if the spotting stops. agf
>> >
>> >>From: "Elrod, Darryl G Maj 48 MDOS/SGOBO"
>><Darryl.elrod@LAKENHEATH.AF.MIL>
>> >>Reply-To: ob-gyn-l@obgyn.net
>> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> >>Subject: mirena and irregular bleeding
>> >>Date: Sat, 17 Feb 2007 09:30:02 -0600
>> >>
>> >>Anyone have any suggestions for persistent spotting 6 months after
>> >>Mirena insertion?
>> >>
>> >>Thanks
>> >>
>> >>Glen
>> >>
>> >>//SIGNED//
>> >>
>> >>D. Glen Elrod, Maj., USAF, MC
>> >>
>> >>Obstetrician/Gynecologist
>> >>
>> >>Chief of Obstetrics
>> >>
>> >>48 MDOS/SGOBO
>> >>
>> >>RAF Lakenheath, England
>> >>
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D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Medical Director, Loch Haven Ob/Gyn Group
Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
Orlando, Florida
