Re: Severe PIH 34 weeks
From: art fougner, md (evsono@pipeline.com)
Thu May 24 10:21:45 2007
Since Redman and Bonnar in 1976 demonstrated a relationship between risk
of perinatal mortality and uric acid level, a uric acid of 4 mg % is
reassuring as far as the perinate is concerned.
Art
At Thu, 24 May 2007, Andrew Folley wrote:
>
>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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art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
