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Re: Opinions please! From: Garry Siegel (garrys@mindspring.com) Sat Feb 26 21:37:30 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Paul Prior MD: "Re: how to get a baby on time" Previous message: Garry Siegel: "GYN: Complex Endometrial Hyperplasia" In reply to: Luis Sanchez-Ramos, MD: "Opinions please!" Next in thread: Efrain Ramirez: "Re: how to get a baby on time" Reply: Efrain Ramirez: "Re: how to get a baby on time" Reply: Efrain Ramirez: "Re: how to get a baby on time" Reply: art fougner, md: "Re: how to get a baby on time" Luis: You are clearly more expert in these matters, but you have presented someone with a 27 weeker (best estimate) that could be a growth restricted 30 or 32 weeker (symmetric)with evidence of uteroplacental insufficiency--oligo, absent end diastolic flow, and 6/10 BPP. Could the mom be a chronic hypertensive as an explanation, or, as mentioned, pre-eclamptic? Is this baby better off in utero or out? It sounds like this baby is at risk for an in utero demise--you really have little that is reassuring, and I'm afraid that you may be forced to deliver it, realizing full well that it is a tiny premature baby. My bottom line is to deliver by section now. Garry At Sat, 26 Feb 2000, Luis Sanchez-Ramos, MD wrote: > >A colleague (MFM) left me the following patient for the week-end: >24 y/o b/f G31011 at 27 weeks' gestation based on a scan performed 6 >days ago (late entry prenatal care). Previous child weighed 2240 g at >"term". The current pregnancy is complicated by the following: marked >oligohydramnios (unresponsive to aggressive IV hydration). On >ultrasound: both kidneys and bladder visualized. Dilated loops of >bowel; rest of anatomy not well-delineated due to oligohydramnios. >Doppler velocimetry showed (AEDV) absent end diatolic velocity. Fetus >is presenting as footling breech and EFW is 1008 grams. Biophysical >profile has been 6/10 (no breathing movements or reactive NST). EFM >shows several variable decelerations (mild to moderate for the most >part). Patient refers "good fetal activity". My partner attempted >transabdominal amnioinfusion but was unsuccessful. The patietn has >received two doses of betamethasone (1 course). There was some >suspicion of preeclampsia with very mild elevation of systolic blood >pressure. Normal labs except for elevated LDH (408 -> 261). >any recommendations?? Thanks. > >-- >Luis Sanchez-Ramos, MD > -- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice Next message: Paul Prior MD: "Re: how to get a baby on time" Previous message: Garry Siegel: "GYN: Complex Endometrial Hyperplasia" In reply to: Luis Sanchez-Ramos, MD: "Opinions please!" Next in thread: Efrain Ramirez: "Re: how to get a baby on time" Reply: Efrain Ramirez: "Re: how to get a baby on time" Reply: Efrain Ramirez: "Re: how to get a baby on time" Reply: art fougner, md: "Re: how to get a baby on time"

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