Re: 28 weeks centralization of flow
From: Andrew Folley (agfolley@hotmail.com)
Thu May 24 16:04:13 2007
Here is an easier one. G1P0 36 year old. 28 weeks with chronic htn has US
done showing 24 week infant 700 grams asymmetric IUGR less 10 percentile
with centralization of flow and flow through ductus venosus diminished. Mom
is 300 pounds. This is a no brainer IMHO. Give steroids and section 12
hours after 2nd dose.
>From: "Richard Kaplan" <rkaplan@triad.rr.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: Thu, 24 May 2007 12:11:48 -0500
>
>Andrew,
>I agree with you on not rushing to deliver this patient. There are no
>signs of placental insufficiency and you are monitoring the patient's blood
>pressure and the fetal condition carefully. We are too willing to make our
>problem the neonatologist's problem. Some 34 wk. preterm babies have
>significant complications in the nursery.
>
>Richard Kaplan
>Greensboro
>
>>----- Original Message ----- From: "Andrew Folley" <agfolley@hotmail.com>
>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
>Sent: Wednesday, May 23, 2007 1:23 PM
>Subject: Re: Severe PIH 34 weeks
>
>>Other than for Barb I seem to be the only dissenting opinion here
>>regarding management. First of all she does not have preeclampsia neither
>>mild nor severe. She has no significant proteinuria. She does have
>>severe hypertension. This may PIH or underlying hypertensiion exacerbated
>>by pregnancy. As I said the pts. labs are all normal. The babies studies
>>are all normal other than the fact that the babies amnio shows immaturity
>>and the baby is LGA at 34 weeks. It is easy to say deliver her by section
>>or whatever but where is the thought process??? Why is this baby better
>>off in the NICU than in the mother hospitalized and under observation?
>>
>>>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: Wed, 23 May 2007 11:33:22 -0500
>>>
>>>IMHO, the hang-up with worrying about the classification of this woman's
>>>admittedly severe HBP has clouded the minds of those managing her care.
>>>Stabilize and deliver is the only logical management. If the nursery
>>>can't handle an 8 pound baby, close the nursery.
>>>
>>>Just my opinion - I could be wrong.
>>>
>>>Art
>>>At Wed, 23 May 2007, Dr Eberhard Lisse wrote:
>>> >
>>> >What are you waiting for?
>>> >
>>> >el
>>> >
>>> >on 5/23/07 4:57 PM Harrison Sheld said the following:
>>> >> Is she a user?
>>> >>
>>> >> Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote:
>>> >>> At Wed, 23 May 2007, Andrew Folley wrote:
>>> >>>
>>> >>>> G1Po 33 weeks 6 days admitted with BP170/110. HELLP labs all
>>> >>>> normal 200mg
>>> >>>> potein in 24 hour urine. Echo 7#15 oz baby vertex AFI 20 >>>>
>>>Doppler
>>> >>>> normal
>>> >>>> MCA and UA. Tracing reactive.
>>> >>>>
>>> >>>> Questions: Deliver or not deliver? How to treat BP? Mg yes or
>>> >>>> no and
>>> >>>> why? What other information needed? agf
>>> >>>>
>>> >>> Whats the cervix like, agree with labetolol , if she had a normal
>>> >>> B.p.
>>> 2
>>> >>> weeks ago and two B.P. levels of 170/110 then she has sevevre
>>> >>> pre-eclampsia. Deliver now, c-section or induction depending on
>>>cervix.
>>> >>> Bethamethasone at 34 wks in severe pre-eclampsia , why bother, you
>>>have
>>> >>> the perfect indication for delievery now; B.p. can take off despite
>>> >>> labetolol and MgSo4, she is set up for aburption and siezure; if she
>>>is
>>> >>> sick enough for MgSo4 then she is sick enough to be delievered now.
>>>If
>>> >>> anything goes wrong she will also be labelled as gestional diabetic
>>>,
>>>is
>>> >>> she obesese?. If she was 27 wks risk analysis may justify
>>> >>> procrastination; a 33 6/7 wk 8 lbs baby with a little rds beats a
>>> >>> dead
>>> >>> 341/7 wks baby any day of the week. Deliever now with a platlet >>>
>>>count
>>> >>> over 150k under spnial/epidural, you may have to do c-section with
>>> >>> platlet count of 20K in 2days.
>>> >>>
>>> >>> --
>>> >>> Take care, John
>>> >>>
>>> >--
>>> >Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
>>> >el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
>>> >PO Box 8421 \ / Please do NOT email to this address
>>> >Bachbrecht, Namibia ;____/ if it is DNS related in ANY way
>>> >
>>>
>>>--
>>>art fougner, md
>>>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>
>
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