|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Re: 17 oh progesteroneFrom: Lynn Montgomery (apgar10@thebirthcentermt.com)Fri Jun 8 10:48:33 2007
I have 3 ladies I am considering starting on 17 OH P at 20 weeks. #1 had an incompetent cervix in first pregnacy with rescue cerclage at 24 weeks and preterm deliviery at 29 weeks. [Lynn] In this patient, I would be more inclined to follow serial cervical lengths from 16 through 24 weeks gestational age. If there is a dynamic change noted during this surveillance, I would place a cervical cerclage at that point. In a patient requiring a rescue cerclage, I would certainly not argue with empirically placing a cerclage at 12-14 weeks and forgo the serial measurements. I do not feel that this is a good patient for progesterone. #2 developed severe preeclampsia and and was induced and delivered early at 28 weeks. [Lynn]In this patient, given the history of severe preeclampsia at 28 weeks gestational age, she has at least a 50% chance of recurrence. Progesterone has certainly not been shown to lessen the recurrence risk of preeclampsia. I would consider starting low-dose aspirin (81mg/day) early and continuing to 36 weeks. I know the large ASA study did not show a significant benefit, however, the study included a large number of randomly chosen primigravidas and there wasn't a decreased incidence when compared to controls. If a there was an early predictor of who was "at risk" to develop preeclampsia in those same groups and only the "at risk" primigravidas where randomized to ASA and no ASA, there may indeed be a benefit. Unfortunately, we do not have that early marker - yet... I always check those early, "atypical" preeclamptics for antiphospholipid antibodies as well - ASA definitely will benefit that group. Finally #3 more delivered second baby at 34 weeks following PROM. [Lynn]In PPROM, it is currently thought that the primary etiology is an ascending bacteria that infects the membrane, weakens it, leading to rupture. As to why this occurs in some, it may be due to shortening of the cervix or other unknown factors. In this case, if shortening is the result of uterine contractions, then progesterone can be argued for. There have been good studies demonstrating that in patients with a history of PPROM, by placing them on nightly antibiotic therapy (erythromycin) throughout the pregnancy, you lessen the recurrence rate of PPROM compared to controls. This likely works by lessening the bacterial load in the vagina, therefore lessening the risk of an ascending infection. I have been doing this for several years and use PCE 500 (well tolerated erythromycin formulation). Lynn
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Tue Sep 2 05:10:44 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.