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Re: Severe PIH 34 weeksFrom: DoctorJoe@aol.comWed May 23 13:16:57 2007
In a message dated 5/23/2007 1:08:17 P.M. Central Daylight Time, AllanHo@aol.com writes: The flip side of this argument is that if you deliver the baby, say by c/s, and the mother died from a PE. Now the burden of proof would be on why the baby had to be delivered so urgently... Because you "think" something bad is going to happen? No, you document what you did and why you did what you did. In this case, a "well grown" baby implies, at least to me, the hypertension is due to preeclampsia. The treatment is delivery. We don't "think" the treatment is delivery -- it is obstetric dogma that the treatment is delivery. If, for the sake of argument, we posit that the HBP is due to chronic hypertension, then that carries a WORSE prognosis as far as abruption and sudden fetal death, since there is chronic small vessel disease, yada, yada, yada. (It doesn't look like that here, since there is no IUGR, oligo, etc., but for the sake of argument ... .) So we don't "think" she needs to be delivered, we know that the stats on severe hypertensives in pregnancy are bad and there is a higher chance of something bad happening from the HBP than, say, a PE postoperatively. All of that goes on the chart, is discussed with the patient, and you do a C/S. If you do it NOW, you'll likely have less maternal morbidity than if you let her "declare" herself. Joe P.
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