Re: 23 weeks prom
From: Joe (forcep@intercom.net)
Tue Feb 20 06:07:27 2007
Good grief: Drudge Report shows picture of apparent 22 week baby that
survived. Joe C
D. Ashley Hill wrote:
> 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
>>>>>
>>>>>Telephone DSN: 314-226-8130
>>>>>
>>>>> Comm: +44 (0) 1638 52 8130
>>>>>
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>>>>
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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
>
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