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Re: Severe PIH 34 weeksFrom: Raymond Stephen (stephen.raymond@dhhs.tas.gov.au)Thu May 24 00:05:16 2007
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.2007.01326.x
>From the latest BJOG a trial in Amsterdam of temporisation in cases of pre-eclampsia, eclampsia, HELLP Syndrome and pregnancy induced hypertension. In all groups a median of 8 days were gained with appropriate treatment. And yes, it is important to distinguish between severe hypertension and pre-eclampsia. End-organ affectation is the whole reason why the condition is of clinical interest; if absent, the pregnancy can continue. Changes in liver, renal or placental function should be sought otherwise you are just practicing cook book medicine. The ten percent of eclamptics who don't have proteinuria before they fit will have other evidence of endothelial disease, and it is wrong to assume that changes in any one organ will be present in any other. The kidney may not be greatly affected when the brain is severely so and vice versa. Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of rmodugno@aol.com Sent: Thursday, 24 May 2007 11:28 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Severe PIH 34 weeks Steve, you say deliver when something is wrong. Is a BP of 170/110 right? She has "Gestational Hypertension?" - is that your contention? Why do ten percent of eclamptics not have proteinuria? Are they not pre-eclamptics before they seize? Do you have to have proteinuria and/or HeLLP to label a P0G1 with a BP170/110 a severe pre-eclamptic? IMHO, no. OK, let's wait for the end organ damage -seizure, abruption. Call me a whimp - but not on my watch! GIT R DUN! Robert Modugno MD MBA FACOG Sylva, NC -----Original Message----- From: Raymond Stephen <stephen.raymond@dhhs.tas.gov.au> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> Sent: Wed, 23 May 2007 7:28 pm Subject: Re: Severe PIH 34 weeks What was her BP at first visit? How old is she? Without abnormality of bloods or urine how can you call this pre-eclampsia? Seems likely that she has essential hypertension. Give her Labetalol until the BP is controlled and watch for end-organ changes including placental function. Deliver when something is wrong, which it isn't yet. Steve ------------------------------------------------------------ From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R. ------------------------------------------------------------ Daniel Braun ------------------------------------------------------------ Sent: Wednesday, 23 May 2007 11:27 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Severe PIH 34 weeks If the BP is that high in a patient at 34 weeks, why do you have a 24 hour urine? Should have been delivered in less than 24 hours. IMHO Dan On 5/23/07, Andrew Folley <agfolley@hotmail.com> 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 -- R. Daniel Braun, MD FACOG(L) CMT Professor Emeritus Dept. of Obstetrics and Gynecology Indiana U. School of Medicine CONFIDENTIALITY NOTICE AND DISCLAIMERThe information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. 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