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Re: Severe PIH 34 weeksFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Wed May 23 10:43:09 2007
At Wed, 23 May 2007, Andrew Folley wrote: > >G1Po 33 weeks 6 days admitted with BP170/110. HELLP labs all normal 200mg >potein in 24 hour urine. Echo 7#15 oz baby vertex AFI 20 Doppler normal >MCA and UA. Tracing reactive. > >Questions: Deliver or not deliver? How to treat BP? Mg yes or no and >why? What other information needed? agf > Whats the cervix like, agree with labetolol , if she had a normal B.p. 2 weeks ago and two B.P. levels of 170/110 then she has sevevre pre-eclampsia. Deliver now, c-section or induction depending on cervix. Bethamethasone at 34 wks in severe pre-eclampsia , why bother, you have the perfect indication for delievery now; B.p. can take off despite labetolol and MgSo4, she is set up for aburption and siezure; if she is sick enough for MgSo4 then she is sick enough to be delievered now. If anything goes wrong she will also be labelled as gestional diabetic , is she obesese?. If she was 27 wks risk analysis may justify procrastination; a 33 6/7 wk 8 lbs baby with a little rds beats a dead 341/7 wks baby any day of the week. Deliever now with a platlet count over 150k under spnial/epidural, you may have to do c-section with platlet count of 20K in 2days.
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Take care, John
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