Re: ACOG Mg tocolytic
From: Andrew Folley (agfolley@hotmail.com)
Wed May 23 12:26:10 2007
Has ACOG come out with a statement on not using MG as a tocolytic yet???
>From: "Andrew Folley" <agfolley@hotmail.com>
>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 12:23:24 -0500
>
>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
>
ACOG Mg
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