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Re: Deliver now or later From: JD Stewart,MD (jdstewartmfmob@hotmail.com) Sat Jun 27 16:41:10 2009 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Deliver now or later" Previous message: Allan: "Deliver now or later" In reply to: Allan: "Deliver now or later" Next in thread: art fougner, md: "Re: Deliver now or later" Darn that dodge ball....always makes for the confusing pregnant headaches.... Surprised they put her through a CT head scan before releasing to the L&D. Did her Hydralazine, Labetalol and MagSo4 get started before then? "coags are normal" -are they showing hemoconcentration, shortened PT/aPTT, positive D-dimers? LFT's beginning to elevate? Are her platelets >100K in light of the degree of hemoconcentration? Drug screen? Cocaine, meth...even among the "nice" patients... BP's this high show the definite risk for CVA/blindness/ continued seizures, etc. Argues strongly against waiting., especially if her other labs are starting to show HELLP. Seizing twice in this setting with these pressures doesn't make one confident that you can safely or confidently rely on 24- 48 hrs for baby's steroids. ` As much as I like steroids, I have a much bigger opinion of how sick/how quick these eclamptic patients can be....Better to cut while she can lie still and her blood will still clot... At Sat, 27 Jun 2009, Allan wrote: > >--000e0cd175483968b5046d56c593 >Content-Type: text/plain; charset=ISO-8859-1 >Content-Transfer-Encoding: 7bit > >33 yo G1 P0 presented @ 25 4/7 weeks EGA after a witness seizure at work. >Brought in by ambulance and seized again in ER. BP 220/160. No significant >past medical history. Husband did say she had headaches for one week and >swelling for two weeks. Also was hit by a dodge ball on her forehead three >days before presentation. She was last seen by her ob two weeks ago when it >was uneventful. She had a negative CT of the head prior to being released >from the ER to L&D. Baby's heart beat now in normal range. Cervix closed, >firm, uneffaced. Cephalic presentation by ultrasound. MgSO4 given in >ER, BP gradually responding to Hydralazine and Labetolol. No coagulation >abnormalities. I am wondering how many of you folks will deliver her right >away, or how many will give her steroids and wait? Thanks in advance for >you input. > >-- >Allan > >--000e0cd175483968b5046d56c593 >Content-Type: text/html; charset=ISO-8859-1 >Content-Transfer-Encoding: quoted-printable > ><div>33 yo G1 P0 presented @ 25 4/7 weeks EGA after a witness seizure at work.  Brought in by ambulance and seized again in ER.  BP 220/160.  No significant past medical history.  Husband did say she had headaches for one week and swelling for two weeks.  Also was hit by a dodge ball on her forehead three days before presentation.  She was last seen by her ob two weeks ago when it was uneventful.  She had a negative CT of the head prior to being released from the ER to L&D.   Baby's heart beat now in normal range.  Cervix closed, firm, uneffaced.  Cephalic presentation by ultrasound.  MgSO4 given in ER, BP gradually responding to Hydralazine and Labetolol.  No coagulation abnormalities.  I am wondering how many of you folks will deliver her right away, or how many will give her steroids and wait?  Thanks in advance for you input.</div> > ><div> </div> ><div>Allan</div> > >--000e0cd175483968b5046d56c593-- > -- JD Stewart, MD MFM up all night, every night 10 years later.. Next message: art fougner, md: "Re: Deliver now or later" Previous message: Allan: "Deliver now or later" In reply to: Allan: "Deliver now or later" Next in thread: art fougner, md: "Re: Deliver now or later"

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