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Re: Another case from Malcolm From: DoctorJoe@aol.com Mon Jun 30 21:20:39 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey H. Klein, MD: "ECC, Cones, and in situ adeno ca of the cervix" Previous message: Ingrid Andenas Chamales, MD: "Re: Unresolved cervicitis" Maybe in reply to: Malcolm Griffiths: "Another case from Malcolm" In a message dated 6/30/97 5:22:13 PM, you wrote: <<New case - 1) First pregnancy. 2) 36+ weeks. 3) Presents to her FP at 36 weeks with generalised pruritis. 4) She's read an article in lay ( parenting ) press about obstetric cholestasis. She tells her FP that's what she thinks she's got. 5) FP says no - you've got a rash - it must be a viral infection ! 6) Rash is maculo-papular, worst in groins, then legs, then upper arms, scarcely anything on forearms, nothing on trunk. 7) Liver function tests show raised bilirubin ( >20 ) and raised transaminases. All other routine labs normal. 8) Decide she does have obstetric cholestasis as she thought - therefore given increased fetal risk ( supposedly ) and recently reported observation that fetla demise is not always predicted by CTG, etc ( AJOG article ), to induce her. 9) Three doses of PGE2 later - no real change in cervix, she's pyrexial, and increasingly unwell. 10) What to do next ? 11) Bear in mind it's now Saturday evening and its the NHS in UK ( ~3rd World ).>> I personally wouldn't deliver her right now unless I have documented maturity. I WOULD give hydroxyzine, cholestyramine, and hydration... and watch the baby like a hawk (as opposed to a dove?). Joe P. Next message: Geffrey H. Klein, MD: "ECC, Cones, and in situ adeno ca of the cervix" Previous message: Ingrid Andenas Chamales, MD: "Re: Unresolved cervicitis" Maybe in reply to: Malcolm Griffiths: "Another case from Malcolm"

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