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Re: Another case from Malcolm From: Malcolm Griffiths (malcolm@mgriff22.demon.co.uk) Thu Jul 3 14:38:58 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Laifer, Dr. Steven: "Re: Another case from Malcolm" Previous message: Ron Helm: "It's Almost Friday!" In reply to: Samir Saidi: "Re: Another case from Malcolm" In message <33BB6FEF.513BBA78@saidi.prestel.co.uk>, Samir Saidi <sam@saidi.prestel.co.uk> writes > >1. Sounds like you may have to deliver her if she's at this stage - but >what does 'increasingly unwell' mean? General malaise, no specific features, the sort of woman who worries an experienced midwife enough that she calls the consultant directly at home, bypassing the registrar/resident. > >2. What were the results of the following: >-USS liver [I presume that if it's Saturday now, it was Friday when she >came in - and your SHO has used all his persuasive powers with the >ultrasonographers:) ] No it was late Friday afternoon when she came in. The liver function tests were done in the hope of either showing obs chlolestasis or reassuring the woman. SO too late to request U/S by time we got LFTs ! >-B19 serology I'm intrigued by this one. It wasn't relevant but I'd like to know more about what you were thinking. In UK district hospitals B19 serology is not sokething we get done esaily on a Saturday evening. >-Bilirubin in the urine? Clear on dipstix. >-IM screen (Glandular fever) Like that one. My wife ( she's an FP ) told me that was the mostly likely diagnosis ! Anyway Monospot was negative. >The point being, if you can find an alternative cause (other than >IHCP/AFLP then you might want to wait until Monday, when the NHS gets >back to work) We were thinking cholestasis initially, which prompted us to seek to expedite delivery at this gestation. We then became additionall concerned about maternal pyrexia from ( presumed ) viraemia. > >3. Try Dilapan (hygroscopic cervical dilator). Use Dilapan for late second trimester terminations ( up to 22w ). Might have been useful here, but still rather unfavourable cervix and thinking we wanted to deliver her sooner rather than later. > >4. How old is she? If she is low risk for DVT, and only having one >pregnancy, no documented benefit in vaginal delivery vs. 'elective' CS? >(Controversial?) Late twenties. Low risk for DVT except slightly plump. I opted for CS too ! > >Similar patient recently, but 35 weeks - itching like crazy, we were >lucky & successful induction, but thickest meconium I've seen. Fetal >assessments and CTG's all normal. Recent paper in one of the US journals which said that obstetric cholestasis was associated with an increased risk of fetal demise and compromise and that the fetal status was not necessarily predicted by the usual tests of CTG, BPP etc. > >Eagerly waiting the Roald-Dahl twist to the plot! > Unless any one gets it soon I'll come clean. Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp., LU6 2DT, UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "It is dangerous to be right on a subject on which the established authorities are wrong." (Voltaire) "But sometimes it's fun :-)" (Griffiths) Next message: Laifer, Dr. Steven: "Re: Another case from Malcolm" Previous message: Ron Helm: "It's Almost Friday!" In reply to: Samir Saidi: "Re: Another case from Malcolm"

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