-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: What's next-steroids after 34 w From: Efrain Ramirez (eramirezt@coqui.net) Wed Apr 30 17:54:37 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: John Robertson: "Re: LAVH on a Uterus Didelphus" Previous message: Ronald Ainsworth: "Re: Group Urges Ban on Medical Giveaways" In reply to: art fougner, md: "Re: What's next-steroids after 34 w" Next in thread: Dr Eberhard Lisse: "Re: What's next-steroids after 34 w" C/S on Monday - baby girl 3# 12 oz.. baby and mother doing well.. Thanks all for the input.. Ef At Tue, 29 Apr 2008, art fougner, md wrote: > >So Ef ... > >Any Follow-up? > >Art > >At Tue, 29 Apr 2008, JD Stewart,MD wrote: >> >>Logic can prevail, if we allow...big studies/ Meta analyses showing a >>smaller head circ and 5% less average body weight have a fatal flaw >>inherent in the study populations in that they do not account for >>factors we know have such an effect- namely smoking ( cited at an >>average 8 ozs less at birth at term), maternal weight gain, drug abuse, >>use, work patterns, history of preterm births ..etc. Some have even >>included twins and anomalous babies. >> >>No long term growth deficits or developmental aberrations in all these >>children of moms with asthma or allergies or CT disorders who have been >>on large repeated doses of steroids have been shown in the last 40 >>years... >> >>Steroids work every day, just as they will continue to work until we are >>buried. The problem is a statistical matter (nearly impossible to >>gather enough data to show an p<.o5 improvement over a baseline 98-99% >>survival without problems..) not a biochemical or physiologic process >>that suddenly stops working on a magic date. >> >>Re: Should we dose/ redose at 34-35-even 36w? Ask yourself- What does it >>hurt? How sure can any of us be about gestational dating? If the baby >>does come "late preterm" and is that 1-2% with problems, who is going to >>defend your "not recognizing her risk for delivering early and and >>failing to offer steroids/progesterone/cerclage/smoking cessation/ >>aromatherapy SOONER?" >> >>Why tocolyse at 34-35-36 if doing so will not improve the outcome >>(unless you give steroids...)? >> >>Questions for article below: Hospitalization/ off work/ tocolysis for >>weeks has no economic cost? >> >>At Sat, 26 Apr 2008, Efrain Ramirez wrote: >>> >>> Neonates born after >>>34 completed weeks of gestation rarely have mortality or major >>>morbidity, but the financial costs remain significant ($7000 per case), >>>and efforts to prevent delivery at this gestational age are probably >>>indicated. Economic costs associated with PTB include the cost of >>>initial hospitalisation, the cost of any chronic diseases resulting from >>>the prematurity and social costs including loss of gainful employment by >>>a family member taking care of the infant or child and loss of potential >>>future earnings of the affected child. >> >> Antenatal steroids, if given to >>>the mother at least 48 hours prior to a PTB, have shown significant >>>reductions in RDS, IVH and NEC. Efforts to prevent, or avoid, PTB >>>include the use of tocolytic agents which have been shown to prolong >>>gestation for a minimum of 48 hours, or longer in some cases. The range >>>of tocolytic agents used to delay or prevent PTB work through many >>>different pathways, with varying degrees of success. Which tocolytic >>>agent to use depends on many factors including underlying maternal >>>status, gestational age of the fetus and documented efficacy of agent >>>used. >>> >>>At Fri, 25 Apr 2008, Garry E. Siegel, M.D. wrote: >>>> >>>>Thanks for the input, Dan and Ef. >>>> >>>>Is there evidence to use steroids as you've suggested, or is it just >>>>based on experience/obstetric horse sense? >>>> >>>>Isn't there a bit of a thought that steroids may have long term growth >>>>consequences? In other words, there may be harm such that one shouldn't >>>>use them unless clearly indicated. >>>> >>>>Garry >>>> >>>>At Thu, 24 Apr 2008, Efrain Ramirez wrote: >>>>> >>>>>Agree!!!! >>>>> >>>>>Ef >>>>> >>>>>At Thu, 24 Apr 2008, R. Daniel Braun wrote: >>>>>> >>>>>>Steroids do more than prevent RDS. They also decrease incidence of IVH and >>>>>>NEC, which can still occur after 34 weeks. Risk of giving steroids is ?????? >>>>>> >>>>>>Dan >>>>>> >>>>>>On Thu, Apr 24, 2008 at 9:05 AM, Andrew Folley <agfolley@hotmail.com> wrote: >>>>>> >>>>>>> I must have missed how the diagnosis of IUGR was made?agf >>>>>>> >>>>>>> > Date: Thu, 24 Apr 2008 06:11:49 -0500 >>>>>>> > From: cdsb@bellsouth.net >>>>>>> > To: ob-gyn-l@mail.obgyn.net >>>>>>> > Subject: RE: What's next >>>>>>> > >>>>>>> > I don't give steroids after 34 weeks either. And Garry is right, the baby >>>>>>> > isn't thriving, it's small. >>>>>>> > >>>>>>> > But if the fetus were say 30 weeks with IUGR, but with Reactive NST and >>>>>>> 8/8 >>>>>>> > BPP, then I think there wouldn't be such a rush to delivery. >>>>>>> > >>>>>>> > So the real question here I think is given an IUGR fetus with perfect >>>>>>> > testing, what is the EGA we would electively deliver? >>>>>>> > >>>>>>> > Everyone may have a different answer. Here is an example of there being >>>>>>> 10 >>>>>>> > different ways to do something in medicine and nine of them not being >>>>>>> wrong. >>>>>>> > >>>>>>> > Charles >>>>>>> > >>>>>>> > -----Original Message----- >>>>>>> > From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry >>>>>>> E. >>>>>>> > Siegel, M.D. >>>>>>> > Sent: Wednesday, April 23, 2008 10:47 PM >>>>>>> > To: Multiple recipients of list OB-GYN-L >>>>>>> > Subject: Re: What's next >>>>>>> > >>>>>>> > Over 34 weeks--no steroids unless amnio done and lung maturity not >>>>>>> > proven. >>>>>>> > >>>>>>> > Yes, the late preterm baby alluded to in ACOG's Committe Bulletin has >>>>>>> > more morbidity, etc., but this baby is far from thriving inside. >>>>>>> > >>>>>>> > Reassuring testing is nice, but nicer is a baby in the nursery. >>>>>>> > >>>>>>> > Deliver her, my friend. >>>>>>> > >>>>>>> > Garry >>>>>>> > >>>>>>> > At Wed, 23 Apr 2008, Efrain Ramirez wrote: >>>>>>> > > >>>>>>> > >No fetal weight gain at all in the last 2 weeks.. umbilical artery >>>>>>> > >doppler normal.. MCA not done.. mother perceives fewer FM's.. just >>>>>>> > >like the other pregnancy. >>>>>>> > >Definitive asymmetric IUGR. >>>>>>> > >Level III NICU .. I had to deliver in the last year to babies at 26 >>>>>>> > >weeks .. doing well.. >>>>>>> > >Steroids? - it's a Democratic Primary.. >>>>>>> > >Legally speaking an unexpected IUFD would be hard to defend... NICU >>>>>>> > >complications, IMHO, easier. >>>>>>> > >Thanks to all.. recommendations well taken. >>>>>>> > > >>>>>>> > >Ef >>>>>>> > > >>>>>>> > >At Wed, 23 Apr 2008, art fougner, md wrote: >>>>>>> > >> >>>>>>> > >>Middle cerebral artery doppler? Uterine artery doppler? >>>>>>> > >>If all normal, would suggest (unencumbered by data) twice weekly nst's >>>>>>> > >>with AFI's, weekly dopplers and elective delivery at term. >>>>>>> > >> >>>>>>> > >>Art >>>>>>> > >> >>>>>>> > >>Just my opinion. I could be wrong. >>>>>>> > >> >>>>>>> > >>At Wed, 23 Apr 2008, Efrain Ramirez wrote: >>>>>>> > >>> >>>>>>> > >>>30 some G2, P1 - previous C/S - IUGR - at 36 weeks - apparently no >>>>>>> > >>>reassuring FHR's.2 weeks at NICU.. at present 34 w and 5 d.. BPP >>>>>>> > >>>10/10, EFW - 1500-1600 below 5th.. normal umbilical Doppler .. what's >>>>>>> > >>>next? >>>>>>> > >>> >>>>>>> > >>>Ef >>>>>>> > >>> >>>>>>> > >>>-- >>>>>>> > >>>"I can accept failure, but I can't accept not trying." - Michael >>>>>>> Jordan >>>>>>> > >>> >>>>>>> > >>-- >>>>>>> > >>art fougner, md >>>>>>> > >>"May The Wings of Liberty Never Lose a Feather." - Jack Burton >>>>>>> > >> >>>>>>> > >-- >>>>>>> > >"I can accept failure, but I can't accept not trying." - Michael Jordan >>>>>>> > > >>>>>>> > >>>>>>> > -- >>>>>>> > Garry E. Siegel, M.D. >>>>>>> > Private Practice >>>>>>> > Roswell, GA >>>>>>> > >>>>>>> >>>>>>> ------------------------------ >>>>>>> Make i'm yours. Create a custom banner to support your cause.<http://im.live.com/Messenger/IM/Contribute/Default.aspx?source=TXT_TAGHM_MSN_Make_IM_Yours> >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> >>>>>>> ------------------------------ >>>>>> >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>-- >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>R. Daniel Braun, MD FACOG(L) ABMP CMTh >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>Professor Emeritus >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>> ------------------------------ >>>>>>Dept. of Obstetrics and Gynecology >>>>>>> ------------------------------ >>>>>>Indiana U. School of Medicine >>>>>>> ------------------------------ >>>>>> >>>>>>R. Daniel Braun >>>>>> >>>>>>"Science without Religion is LAME; Religion without Science is BLIND" >>>>>>Einstein 1941 >>>>>> >>>>>-- >>>>>"I can accept failure, but I can't accept not trying." - Michael Jordan >>>>> >>>>-- >>>>Garry E. Siegel, M.D. >>>>Private Practice >>>>Roswell, GA >>>> >>>-- >>>"I can accept failure, but I can't accept not trying." - Michael Jordan >>> >>-- >>JD. Stewart, MD >>MFM up too late all night, every night...still 10 years later >> >-- >art fougner, md >"May The Wings of Liberty Never Lose a Feather." - Jack Burton > -- "I can accept failure, but I can't accept not trying." - Michael Jordan Next message: John Robertson: "Re: LAVH on a Uterus Didelphus" Previous message: Ronald Ainsworth: "Re: Group Urges Ban on Medical Giveaways" In reply to: art fougner, md: "Re: What's next-steroids after 34 w" Next in thread: Dr Eberhard Lisse: "Re: What's next-steroids after 34 w"

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: Thu Oct 2 04:59:26 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.