Re: Severe PIH 34 weeks
From: Joe (forcep@intercom.net)
Wed May 23 18:19:33 2007
Andrew: I respect your decision. 95 % of the time everything will turn
out well hopefully. If it doesn't , in court you will be faced with the
definition of severe preeclampsia , based on BP alone. Once the expert
witness defines that he will be asked what the definitive treatment is.
He will respond , "immediate delivery". I admire your convictions. I
appreciate my experience in court. Joe C
Andrew Folley wrote:
> 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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