Re: Severe PIH 34 weeks
From: art fougner, md (evsono@pipeline.com)
Thu May 24 05:42:53 2007
Just curious - what is the blood uric acid level?
Art
At Wed, 23 May 2007, 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
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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