Re: Severe PIH 34 weeks
From: Andrew Folley (agfolley@hotmail.com)
Wed May 23 12:22:07 2007
Other than for Barb I seem to be the only dissenting opinion here regarding
management. First of all she does not have preeclampsia neither mild nor
severe. She has no significant proteinuria. She does have severe
hypertension. This may PIH or underlying hypertensiion exacerbated by
pregnancy. As I said the pts. labs are all normal. The babies studies are
all normal other than the fact that the babies amnio shows immaturity and
the baby is LGA at 34 weeks. It is easy to say deliver her by section or
whatever but where is the thought process??? Why is this baby better off in
the NICU than in the mother hospitalized and under observation?
>From: evsono@pipeline.com (art fougner, md)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: Severe PIH 34 weeks
>Date: Wed, 23 May 2007 11:33:22 -0500
>
>IMHO, the hang-up with worrying about the classification of this woman's
>admittedly severe HBP has clouded the minds of those managing her care.
>Stabilize and deliver is the only logical management. If the nursery
>can't handle an 8 pound baby, close the nursery.
>
>Just my opinion - I could be wrong.
>
>Art
>At Wed, 23 May 2007, Dr Eberhard Lisse wrote:
> >
> >What are you waiting for?
> >
> >el
> >
> >on 5/23/07 4:57 PM Harrison Sheld said the following:
> >> Is she a user?
> >>
> >> Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote:
> >>> 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.
> >>>
> >>> --
> >>> Take care, John
> >>>
> >--
> >Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
> >el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
> >PO Box 8421 \ / Please do NOT email to this address
> >Bachbrecht, Namibia ;____/ if it is DNS related in ANY way
> >
>
>--
>art fougner, md
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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