Re: 28 weeks centralization of flow
From: Andrew Folley (agfolley@hotmail.com)
Fri May 25 10:40:00 2007
I like your correlation of arterial = hypoxemia and venous = acidosis with
dopplers.
>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: 28 weeks centralization of flow
>Date: Fri, 25 May 2007 07:40:16 -0500
>
>Andrew
>
>Abnormal arterial dopplers connote hypoxemia.
>Abnormal venous dopplers connote acidemia.
>
>Delivery seems prudent.
>
>Art
>
>At Thu, 24 May 2007, Andrew Folley wrote:
> >
> >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
> >>>
> >_________________________________________________________________
> >PC Magazine’s 2007 editors’ choice for best Web mail—award-winning
> >_________________________________________________________________
>Windows
> >
> >--
> >_________________________________________________________________
> >Live Hotmail.
> >_________________________________________________________________
> >http://imagine-windowslive.com/hotmail/?locale=en-us&ocid=TXT_TAGHM_migration_HM_mini_pcmag_0507
> >
>
>--
>art fougner, md
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
