Re: Severe PIH 34 weeks
From: Joe (forcep@intercom.net)
Thu May 24 06:26:46 2007
Sabai has defined this entity in one of the most read articles last year
in Green J. Joe C
Garry E. Siegel, M.D. wrote:
> I've got some grey, too.
>
> She has gestational hypertension, severe by BP criteria.
>
> Call it what you would like, but she needs BP control, seizure
> prophylaxis, and delivery by whichever method (hint--there are two
> choices) seems best given her cervical examination and after discussion
> with her.
>
> Garry
>
> At Wed, 23 May 2007, R. Daniel Braun wrote:
>
>>Sorry I left EL off htat list. Now if Steve Raymond would just weigh in, you
>>would have an historic agreemtent.
>>
>>Dan
>>
>>On 5/23/07, R. Daniel Braun <rd.braun@gmail.com> wrote:
>>
>>>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
>>>
>>
>>--
>>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
>>
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
|
|
