Re: Severe PIH 34 weeks
From: Andrew Folley (agfolley@hotmail.com)
Thu May 24 08:54:45 2007
Agree she has severe HTN and needs control. It is controlled after
admission with labetalol 200 tid and procardia 10 tid. I agree with mg
seizure prophylaxis but also contoversial. Why does she need delivery???
>From: garrys@mindspring.com (Garry E. Siegel, M.D.)
>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 20:38:06 -0500
>
>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
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