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Re: Central Previa, Contracting, Pulmonary Edema From: art fougner, md (evsono@pipeline.com) Mon Aug 21 09:08:24 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Caitlin Cusack: "Job Alternatives" Previous message: Braun, R. Daniel: "Re: Central Previa, Contracting, Pulmonary Edema" In reply to: Joanne Bulley, MD: "Worth Reading" Next in thread: art fougner, md: "Re: Date: Mon, 21 Aug 2000 06:46:32 -0500" and now for something completely different - Should intravenous tocolysis be considered beyond 34 weeks’ gestation? Stephen C. Jones, MDa [MEDLINE LOOKUP] Brian C. Brost, MDb [MEDLINE LOOKUP] Walter T. Brehm, MSa [MEDLINE LOOKUP] Keesler Air Force Base, Mississippi, and Toledo, Ohio Abstract TOP Objective: Our purpose was to assess the incidence of respiratory distress syndrome in nonindigent women with uncomplicated preterm labor between 34 and 36 weeks’ gestation. Study Design: All women seen between June 1, 1992, and April 15, 1999, with uncomplicated preterm labor and intact membranes and delivering between 34 and 36 weeks’ gestation were analyzed. Rates of respiratory distress syndrome after delivery were calculated. A 2 analysis was performed, and a P value of < .05 was considered statistically significant. Results: Respiratory distress syndrome was noted in 8 (17.4%) of 46 infants delivered at 34 weeks’ gestation, in comparison with 5 (6.3%) of 80 infants and 7 (4.2%) of 165 infants delivered at 35 and 36 weeks’ gestation, respectively (P = .008). The rate of respiratory distress syndrome after delivery at 34 weeks was significantly higher than at 35 weeks (P = .048). Conclusion: The rate of respiratory distress syndrome after delivery at 34 weeks is significantly higher than at either 35 or 36 weeks’ gestation in our population. (Am J Obstet Gynecol 2000;183:356-60.) : Am J Obstet Gynecol 1980 Jul 15;137(6):687-95 Related Articles, Books, LinkOut The conservative aggressive management of placenta previa. Cotton DB, Read JA, Paul RH, Quilligan EJ One hundred and seventy-three cases of placenta previa managed at the Women's Hospital of Los Angeles County-University of Southern California Medical Center from July, 1975, through June, 1978, were reviewed and compared to a similar series of cases studied in the same institution in 1969. The perinatal mortality of 12.6% was roughly one half of that in the earlier study. The fetal death rate did not change significantly, but the neonatal mortality was markedly less, especially in the 27-to-32-week range. Expectant management was employed in 65.8% of patients, as compared to 42.6% in 1969. The higher rate of expectant management was characterized by the aggressive use of antepartum transfusions in the face of moderate-to-severe bleeding in lieu of delivery, as well as the occasional use of tocolytic agents for inhibition of premature labor in the presence of vaginal bleeding. Elective termination of pregnancy utilizing the lecithin/sphingomyelin (L/S) ratio for determination of pulmonary maturation also resulted in significantly less overall neonatal morbidity and mortality. These multiple factors appear to have contributed to a dramatic reduction in the perinatal mortality associated with placenta previa. not saying i agree but this certainly is food for thought. art At Mon, 21 Aug 2000, Braun, R. Daniel wrote: > >34 weeks with at least 48 hours of betamethasone(I hope since you didn't >mention it), I would call a consult with Drs. Bard and Parker. Tertiary NICU >should have an 95 to 98% survival rate. Giving more tocolysis will put her >in severe Pulmonary edema and not giving it will lead to heavier bleeding >and need for emergency section. > >The reason for not giving terb is that it causes uterine relaxation in a >patient who is bleeding. The same reasoning applies to all other tocolytic >agents including Magnesium. That is why bleeding is listed as a >contraindication. > >Dan > >R. Daniel Braun, MD FACOG >Clinical Professor >Department of Obstetrics and Gynecology >Indiana U. School of Medicine >Indianapolis, IN 46202 > >OBGYN.net >International Representative for United States > >Certified AllExperts Expert >Check out my bio/ratings page! >http://www.allexperts.com/displayExpert.asp?Expert=1236 > >-----Original Message----- >From: garrys@mindspring.ocm [mailto:garrys@mindspring.ocm] >Sent: Saturday, August 19, 2000 10:03 PM >To: Multiple recipients of list OB-GYN-L >Subject: OB: Central Previa, Contracting, Pulmonary Edema > >Here's one: > >30 YO P0 at 33w5d, hospitalized by another physician for whom I am >covering this week, is in for premature contractions, asymptomatic, but >a shortened cervix on ultrasound (I forgot the mm), and a central >previa, no bleeding. She has been here about a week, on Mag Sulfate at >1 gm/hour this AM, and total IVF of 150 cc/hr. I remember seeing a jot >about not using terbutaline, but I don't remember why. > >Anyway, this AM just before rounds she complained of a bit of SOB and >chest pain, and the nurse called me and pointed out: > >She was on Mag plus IVF at 150 cc/hour >She had gained 7 pounds in a week > >Rocket scientist that I am, I suggested to the nurse that we probably >should stop trying to drown this woman, and that I was on the way. > >Exam: No acute distress, RR 18, P92, BP 100/60 >Lungs: Rales 1/2 way up >CV: reg without gallop; 2/6 SEM of pregnancy >Abd: soft, not contracting > >Pulse ox: 91% Room Air >ABG RA 7.47/P CO2 26/P O2 61-91% sat >chem panel--SGOT 48, K+ 2.7, others cool >CBC--Hct. 27 (no change), platelets 250K > >So, she likely was in early pulmonary edema, and hypokalemic, and I >can't yet explain the SGOT elevation. > >She responded nicely to limiting IVF, supplementing some K+ both IV and >orally, and using a bit of IV Lasix and IV Morphine. I saw her 8 hours >later, and she looked great. > >Now, a few hours later, she is contracting 10/hour, not bleeding, no >symptoms. > >Would you initiate tocolysis? > >(I know my answer--what's yours? P.S.--don't hassle me about why she was >on Mag so long, or the IVF--I inheirited this woman :)). > >Garry > >-- >Garry E. Siegel, M.D., F.A.C.O.G. >Private Practice >Roswell, GA > -- art fougner, md A series of 1000 cases begins with but a single anecdote. Next message: Caitlin Cusack: "Job Alternatives" Previous message: Braun, R. Daniel: "Re: Central Previa, Contracting, Pulmonary Edema" In reply to: Joanne Bulley, MD: "Worth Reading" Next in thread: art fougner, md: "Re: Date: Mon, 21 Aug 2000 06:46:32 -0500"

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