Re: Post Partum Hypertension
From: Andrew Folley (agfolley@hotmail.com)
Sat Jun 9 11:48:26 2007
Is anyone treating women who had pregnancies complicated by mild
preeclampsia or with mild PIH who are now day 1 or 2 post partum and
continue to have high BP ie 140-150/90-110???
I see no reason to treat but several colleagues want to send them home on
Labetalol etc for 6 weeks? agf
>From: Charlie Chambers <ricechaz@earthlink.net>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: prom
>Date: Fri, 8 Jun 2007 16:32:45 -0500
>
>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.
>************************************************************************
>*******
>
>
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