Re: prom
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri Jun 8 21:04:28 2007
If at term, and the GBS is negative, no.
If at term, GBS positive, of course.
If at term, GBS unknown, I would follow CDC guidelines.
If preterm and being induced (i.e. 35 weeks), I would culture and cover
for GBS.
Garry
At Fri, 8 Jun 2007, Charlie Chambers wrote:
>
>What about if induction is started and delivery appears greater than
>24 hours away, would you give antibiotics prophylactically?
>
>On Jun 8, 2007, at 2:19 PM, Garry E. Siegel, M.D. wrote:
>
>> Ashley makes a very good point--but I think a quick admission scan for
>> presentation is paramount. For those of us who don't routinely do
>> their
>> own scans (I am very slow but can do it), a quick look at fluid and
>> presentation is a good idea.
>>
>> Term PROM? Induce. . .
>>
>> Garry
>>
>> At Fri, 8 Jun 2007, D. Ashley Hill wrote:
>>>
>>> I would add one more thing: keep fingers out of the vagina! We take a
>>> lot of transfers from outlying hospitals via ambulance or
>>> helicopter of
>>> PPROM patients, and it's a real challenge to keep physicians,
>>> midwives
>>> and nurses from performing 1 (or more) digital exams. Not too
>>> long ago
>>> a patient got 3 digital exams prior to transfer! Either they don't
>>> know
>>> that digital exams can shorten the latent phase to delivery, or
>>> they are
>>> afraid of putting someone in a helicopter without knowing if they are
>>> dilated. We advise a speculum exam prior to transfer, which
>>> should do
>>> the trick. Have a good w/e.
>>>
>>> Ashley
>>>
>>> At Fri, 8 Jun 2007, Lynn Montgomery wrote:
>>>>
>>>> Question to the group to achieve some sort of consensus: in
>>>> premature
>>>> rupture of membranes, what are the opinions of starting antibiotics?
>>>> Wait for fever, start if delivery is not anticipated or achieved,
>>>> any
>>>> other guidelines? We're trying to come up with some guidelines, and
>>>> after discussion, all of us are all over the map.
>>>>
>>>> Charlie,
>>>>
>>>> Typically, what I do is start ampicillin 2 grams q4h and
>>>> continue this
>>>> for 48 hours, regardless of culture results (60-70% will deliver
>>>> within
>>>> 48 hours regardless). If a patient makes it 48 hours, then I switch
>>>> them to the "Mercer protocol", which includes oral
>>>> amoxicillin/erythromycin - I know, it is a strange combination,
>>>> but the
>>>> one studied - I presume the EES is for mycoplasma/ureaplasma.
>>>> Studies
>>>> have shown that this extends the latent period prior to delivery
>>>> compared with controls (range from 5-7 days longer) without
>>>> increasing
>>>> neonatal infectious morbidity. Studies have also shown that of the
>>>> those remaining undelivered at 48 hours, they will deliver at a
>>>> rate of
>>>> 50% each week thereafter.
>>>>
>>>> If, at anytime during their hospitalization, they go into labor,
>>>> I will
>>>> check a WBC, as well as assess for fever. If, based on this,
>>>> they seem
>>>> clinically infected (cause there is very likely an intrauterine
>>>> infection whether manifest as just labor or other signs) I will
>>>> begin
>>>> broader spectrum antibiotics during labor. If they do not manifest
>>>> findings of a clinical infection (beyond labor), I don't start
>>>> antibiotics because delivery will take care of any sub-clinical
>>>> infection in most cases.
>>>>
>>>> Lynn
>>>
>>> --
>>> D. Ashley Hill, MD
>>> Associate Director
>>> Department of Obstetrics and Gynecology
>>> Florida Hospital Family Practice Residency
>>> Medical Director, Loch Haven Ob/Gyn Group
>>> Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>>> Orlando, Florida
>>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>
>************************************************************************
>****
>
>--
>************************************************************************
>Charlie Chambers
>Hood River, OR
>cchamber@alumni.rice.edu
>
>"Almost anything you do will seem insignificant but it is very important
>that you do it....You must be the change you wish to see in the world"
> -- Mahatma Ghandi.
>************************************************************************
>*******
>************************************************************************
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
