Re: Severe PIH 34 weeks
From: Andrew Folley (agfolley@hotmail.com)
Thu May 24 09:45:21 2007
Good point. Creatinine 0.5 uric acid 4 LFTs all normal platelets
300,000.
>From: evsono@pipeline.com (art fougner, md)
>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: Thu, 24 May 2007 05:45:46 -0500
>
>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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