Re: Severe PIH 34 weeks
From: Andrew Folley (agfolley@hotmail.com)
Wed May 23 16:31:33 2007
Have to respectfully disagree with you in spite of your gray hair. I am not
aware that PIH is the same animal as preeclampsia and is treated the same.
We still have to "practice" medicine and work within the guidelines of
medical knowledge and not do a knee jerk reaction and say "get her
delivered" to every problem making it an NICU problem and not an OB problem.
Agreed BP 170/110 is a medical emergency and needs to be treated quickly.
Treatment does not necessarily warrant delivery. Show me the literature to
support delivery. I still have not seen a reason why the baby at 33w 5d is
better off in the NICU than in the mother. Moms BP is controlled with
labetalol and procardia at this time.
>From: "R. Daniel Braun" <rd.braun@gmail.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 14:53:38 -0500
>
>You got enough Gray hair on this list telling you to deliver that you don't
>need to worry about all that other stuff.
>Myself, Joe C, Joe P, Art, Bob, et al.
>
>BTW BP 110 diastolic is a medical emergency in any patient, pregnant or
>not,
>PIH or not, Toxemia or not, Essential Hypertension or not. It needs to be
>lowered right away to prevent blowing out a vessel in the Squash. PIH is
>just a variant of toxemia and should be treated the same. IMHO.
>
>Dan
>
>On 5/23/07, DoctorJoe@aol.com <DoctorJoe@aol.com> wrote:
>>
>> 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.
>>
>> ------------------------------
>>See what's free at AOL.com
>> ------------------------------
>><http://www.aol.com/?ncid=AOLAOF00020000000503>.
>> ------------------------------
>>
>
>--
>R. Daniel Braun, MD FACOG(L) CMT
>Professor Emeritus
>Dept. of Obstetrics and Gynecology
>Indiana U. School of Medicine
>
>R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage
>everyday".
> Hippocrates
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