Re: OB-GYN-L digest 1221
From: Alenka Pretnar-Darovec (alenka.pretnar-darovec@guest.arnes.si)
Thu Nov 9 05:44:56 2000
Re: Depo a procoagulant
Your friend has probaly all blood tests ( Factor V- Leiden, protein C, Factor X etc ) done. Although if all negative and if she get depo Provera, progestagen will be accused for promotor if relapse occured. Anyway- anticoagulants as well as depo Provera influenced negatively on bone density. Intrauterine devices althuogh with progestagen for therapy were not advisable for nuligravidas ( expulsions, PID ). You can advise her only bed rest and Kalcium , Ferrum, uterotonics at menstrual periods.
ob-gyn-l@obgyn.net wrote:
> OB-GYN-L Digest 1221
>
> Topics covered in this issue include:
>
> 1) Re: men and sections
> by evsono@pipeline.com (art fougner, md)
> 2) FRI:A new twist on politics
> by "Richard Chudacoff, MD" <rchudacoff@mylinuxisp.com>
> 3) Re: Depo a pro-coagulant?
> by Terrence Jones <Terrence.Jones@kp.org>
> 4) RE: men and sections
> by "Braun, R. Daniel" <rbraun@iupui.edu>
> 5) Re: Depo a pro-coagulant?
> by john.robertson@medispecialty.com (John Robertson MD)
> 6) Re: MgSO4
> by "Dr. Rupak Ranjan Roy" <rupakroy@vsnl.com>
> 7) Re: men and sections
> by islesannie@yahoo.com (Joanne Bulley)
> 8) Re: Depo a pro-coagulant?
> by eramirez@icepr.com (Efrain Ramirez)
> 9) Re: men and sections
> by eramirez@icepr.com (Efrain Ramirez)
> 10) Re: Depo a pro-coagulant?
> by eramirez@icepr.com (Efrain Ramirez)
> 11) Re: Depo a pro-coagulant?
> by eramirez@icepr.com (Efrain Ramirez)
> 12) OB: AFP Triscreens in subsequent pregnancies
> by garrys@mindspring.com (Garry Siegel)
> 13) OB: Meconium/new resuscitation stuff
> by garrys@mindspring.com (Garry Siegel)
> 14) OB: Placental Mosaism
> by garrys@mindspring.com (Garry Siegel)
> 15) OB: Kidd JK(A) sensitization
> by garrys@mindspring.com (Garry Siegel)
> 16) Re: men and sections
> by "Robert J. Woolley" <wooll005@tc.umn.edu>
> 17) Re: Depo a pro-coagulant?
> by "Robert J. Woolley" <wooll005@tc.umn.edu>
> 18) Re: OB: Meconium/new resuscitation stuff
> by Kathi Wilson <wilsonk@gtn.on.ca>
> 19) Re: OB: Placental Mosaism
> by Terrence Jones <Terrence.Jones@kp.org>
> 20) Re: OB: Placental Mosaism
> by Paul Prior MD <pprior@clover.net>
> 21) RE: AFP Triscreens in subsequent pregnancies
> by "K Dew" <kdew@bellsouth.net>
>
> ----------------------------------------------------------------------
>
> ----------------------------------------------------------------------
> Date: Tue, 7 Nov 2000 14:22:34 -0600 (CST)
> ----------------------------------------------------------------------
> From: evsono@pipeline.com (art fougner, md)
> To: OB-GYN-L@OBGYN.NET
> Subject: Re: men and sections
> Message-ID: <200011072022.OAA14996@mail.medispecialty.com>
>
> to be sure an undertaking of mammoth proportions.
>
> art
>
> At Tue, 7 Nov 2000, Richard Chudacoff, MD wrote:
> >
> >What? We have found someone who can silence the Woolley? :)
> >
> >Rick
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Robert J.
> >Woolley
> >Sent: Monday, November 06, 2000 9:48 PM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Re: men and sections
> >
> >In message <3A07716E.6AAFD2D8@home.com> writes:
> >>
> >> "Robert J. Woolley" wrote:
> >>
> >> > IMy wife internist, a female, who also happens to be one of my partners,
> >> > tries
> >> > hard to refer her female patients only to female specialists.
> >>
> >> Has she explained to you why she does this, Bob?
> >
> >I never asked, and probably won't.
> >
> >--
> >---------------------------------------------------------------------------
> >
> >---------------------------------------------------------------------------
> >---------------------------------------------------------------------------
> >---------------------------------------------------------------------------
> >Bob Woolley
> >---------------------------------------------------------------------------
> >St. Paul, Minnesota
> >---------------------------------------------------------------------------
> >
> >---------------------------------------------------------------------------
> >GIC
> >
> >Marjorie Williams reported in the August 4 *Washington Post* that "In
> >a recent poll by the Pew Research Center for the People and the Press,
> >54 percent of those questioned said that Bush 'has relied on family
> >connections to get ahead.'" The other 46 percent said that they had
> >recently arrived from another planet.
> >
> > -- David Boaz
> >
>
> --
> art fougner, md
>
> A series of 1000 cases begins with but a single anecdote.
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 15:15:57 -0600
> ------------------------------
> From: "Richard Chudacoff, MD" <rchudacoff@mylinuxisp.com>
> To: <ob-gyn-l@obgyn.net>
> Subject: FRI:A new twist on politics
> Message-ID: <LAEEJEBMFIKDMOCFFABMOEHKCHAA.rchudacoff@mylinuxisp.com>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: 7bit
>
> http://www.colonize.com/warp/index.html
>
> Richard Chudacoff, MD
> Chudacoff Obstetrics & Gynecology, PLLC
>
> 15200 Southwest Freeway, #270
> Sugar Land, TX 77478
> Tel: 281-277-3900
> Fax: 281-277-3901
>
> rchudacoff@mylinuxisp.com
> Richard.Chudacoff@obgyn.net
> **********************************************************************
> Neither the confidentiality nor the integrity of this message
> can be guaranteed following transmission on the Internet.
> **********************************************************************
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of art
> fougner, md
> Sent: Tuesday, November 07, 2000 2:27 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: men and sections
>
> to be sure an undertaking of mammoth proportions.
>
> art
>
> At Tue, 7 Nov 2000, Richard Chudacoff, MD wrote:
> >
> >What? We have found someone who can silence the Woolley? :)
> >
> >Rick
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Robert J.
> >Woolley
> >Sent: Monday, November 06, 2000 9:48 PM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Re: men and sections
> >
> >In message <3A07716E.6AAFD2D8@home.com> writes:
> >>
> >> "Robert J. Woolley" wrote:
> >>
> >> > IMy wife internist, a female, who also happens to be one of my
> partners,
> >> > tries
> >> > hard to refer her female patients only to female specialists.
> >>
> >> Has she explained to you why she does this, Bob?
> >
> >I never asked, and probably won't.
> >
> >--
> >---------------------------------------------------------------------------
> >
> >---------------------------------------------------------------------------
> >---------------------------------------------------------------------------
> >---------------------------------------------------------------------------
> >Bob Woolley
> >---------------------------------------------------------------------------
> >St. Paul, Minnesota
> >---------------------------------------------------------------------------
> >
> >---------------------------------------------------------------------------
> >GIC
> >
> >Marjorie Williams reported in the August 4 *Washington Post* that "In
> >a recent poll by the Pew Research Center for the People and the Press,
> >54 percent of those questioned said that Bush 'has relied on family
> >connections to get ahead.'" The other 46 percent said that they had
> >recently arrived from another planet.
> >
> > -- David Boaz
> >
>
> --
> art fougner, md
>
> A series of 1000 cases begins with but a single anecdote.
>
> ------------------------------
>
> ------------------------------
> Date: 07 Nov 2000 14:54:17 -0800
> ------------------------------
> From: Terrence Jones <Terrence.Jones@kp.org>
> To: ob-gyn-l <ob-gyn-l@forum.obgyn.net>
> Subject: Re: Depo a pro-coagulant?
> Message-ID: <"017DB3A08881956F*/c=us/admd= /prmd=kp/o=notes/s=Jones/g=Terrence/"@MHS>
> Content-Identifier: 017DB3A08881956F
> Content-Return: Allowed
>
> Think Paul summed up DMPA and absent hemostatic effects. Tho this does not address the issue of intraperitoneal bleeding with ovulation. Dr. Grimes pointed out the benefits of ovarian suppression in His intro to the AJOG supplement - "Contraceptive choices for Women with Medical Problems" (6/93, vol 168). See the article by Comp & Zacur on pp 1990-93, as well. Just titre the INR to offset the effects of BCP, and even consider 'seasonal' withdrawal bleed to eliminate any problems with monthly cycling. Wonder, if Her problem is platelet based, did She fail trial of ASA? Clopidogrel? Does she show hyperaggregability in properly obtained venesection sample. Is it enhanced by catechols? If not Sticky platelet syndrome, or Wien-Penzing (lipo-oxygenase defect), perhaps a trial with one of the IV GPIIbIIIa inhibitors (reopro/aggrastat/integrilin) might determine the feasability of oral inhibitors when available (now completing phase II trials - Newby (Duke) Curr Cardiol Rep 9/00, 2:37!
> !
> 2-7). If ASA was never tried, consider Helgason's comparison (to Warfarin) in Pts with platelet aggregation disorder & CVA (Stroke '93, 24:1458-61). Their Lab (Univ of Illinois) is not that far - might consider sending a sample? Think Zach, in his axiomatic way, might be overly pessimistic re: future pregnancy outcome. The study by Bick on recurrent pregnancy loss identified 179 Pts with no anatomic/hormonal/chromosomal cause. Of the 160 Pts. screened, 150 (94%) had identifyable thrombophilic abnormalities. Of these, 20% were platelet-derived. All but 2, of 149, had successful pregnancy outcomes with LDA + low dose (unfractionated) heparin 5000 bid (Clin Appl Thromb Hemost 7/00, 6:115). If Her Docs want more conservative approach, consider q3 month lupron with Climara and Crinone. She's fortunate to have You as a Friend. Joe (TM), "If the shoe fits, wear it" is far too pedantic. Perhaps a better response might be that summation of Monsterpiece Theatre's production of 'Taming o!
> !
> f the Shoe', by Alistair Cookie - "To thine own self, be Shoe". tj
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 18:26:37 -0500
> ------------------------------
> From: "Braun, R. Daniel" <rbraun@iupui.edu>
> To: "'Multiple recipients of list OB-GYN-L '" <ob-gyn-l@forum.obgyn.net>
> Subject: RE: men and sections
> Message-ID: <916D2E5312EED311B98300508BC21798AB8807@iupuimbx05.uits.iupui.edu>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
>
> Yeah, and I was beginning to think (Infinitive, not split) that he was a
> wimp at home.
> Sure am relieved to hear that's not true.
>
> Dan
>
> -----Original Message-----
> From: Griffiths Malcolm (RC9) Luton & Dunstable Hospital TRTo: Multiple recipients of list OB-GYN-L
> Sent: 11/7/00 2:00 PM
> Subject: RE: men and sections
>
> Shit Bob we started a whole new thread then over a typo you made!
>
> -----Original Message-----
> From: Robert J. Woolley [mailto:wooll005@tc.umn.edu]
> Sent: 07 November 2000 13:05
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: men and sections
>
> In message <dd.bde7d84.2738d934@aol.com> writes:
> >
> > In a message dated 11/6/00 9:07:22 PM, cherivh@home.com writes:
> >
> > << "Robert J. Woolley" wrote:
> >
> > > IMy wife internist, a female, who also happens to be one of my
> partners,
>
> > tries
> > > hard to refer her female patients only to female specialists.
> >
> > Has she explained to you why she does this, Bob? Do you agree with
> her
> > reasons?
> >
> > Cheri Van Hoover, CNM >>
> >
> > Yeah, Bob, you're not married to one of those feminazis, are you?!?
> >
> > Joe P.
>
> I had a typo that may have introduced a misunderstanding. The first
> words
> should
> have been "My wife's internist...." My wife is not a physician.
>
> --
> ------------------------------------------------------------------------
> ---
> ------------------------------------------------------------------------
>
> ------------------------------------------------------------------------
> Bob Woolley
> St. Paul, Minnesota
>
> GIC
>
> Marjorie Williams reported in the August 4 *Washington Post* that "In
> a recent poll by the Pew Research Center for the People and the Press,
> 54 percent of those questioned said that Bush 'has relied on family
> connections to get ahead.'" The other 46 percent said that they had
> recently arrived from another planet.
>
> -- David Boaz
>
> **********************************************************************
> This email and any files transmitted with it are confidential and
> intended solely for the use of the individual or entity to whom they
> are addressed. If you have received this email in error please notify
> the system manager.
>
> This footnote also confirms that this email message has been swept by
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>
> **********************************************************************
>
> ------------------------------
>
> Date: Tue, 7 Nov 2000 18:17:56 -0600 (CST)
> From: john.robertson@medispecialty.com (John Robertson MD)
> To: OB-GYN-L@OBGYN.NET
> Subject: Re: Depo a pro-coagulant?
> Message-ID: <200011080017.SAA01534@mail.medispecialty.com>
>
> Just reading the comment, and anecdotally - there is a receptionist in a
> GP office here in town who swears her severe asthma (several ICU
> admissions) was drastically reduced once she started on Depo (used to be
> in ICU on average once a year - hasn't had a significant respiratory
> problem in 2 years). John
>
> At Mon, 6 Nov 2000, Robert J. Woolley wrote:
> >
> >In message <3A077331.17E8F449@mindspring.com> writes:
> >>
> >> Along the way, comprehensive evaluation for thrombophilia almost
> >> certainly has been done.
> >
> >Yes. It's been narrowed down to a platelet disorder rather than a clotting
> >factor disorder, but the university's hematologists aren't able to name a
> >specific disorder.
> >
> >These results, as well as morbidity reported in
> >> your note, might well cast grave doubt on probability of successful
> >> outcome of pregnancy.
> >
> >She knows that. She also has severe asthma. She knows that it's unlikely that
> >she'll ever be in a sufficient state of health to make pregnancy both safe and
> >successful. But, understandably, she doesn't want to completely shut the door
> >yet. Hope spring eternal. She's definitely not foolish enough to say that she's
> >going to have a baby no matter what, but she also fears the later regret if her
> >health should improve enough to make pregnancy possible in the future if only
> >she hadn't had the endometrial ablation.
> >
> >--
> >---------------------------------------------------------------------------
> >
> >---------------------------------------------------------------------------
> >---------------------------------------------------------------------------
> >---------------------------------------------------------------------------
> >Bob Woolley
> >---------------------------------------------------------------------------
> >St. Paul, Minnesota
> >---------------------------------------------------------------------------
> >
> >---------------------------------------------------------------------------
> >GIC
> >
> >Marjorie Williams reported in the August 4 *Washington Post* that "In
> >a recent poll by the Pew Research Center for the People and the Press,
> >54 percent of those questioned said that Bush 'has relied on family
> >connections to get ahead.'" The other 46 percent said that they had
> >recently arrived from another planet.
> >
> > -- David Boaz
> >
>
> --
> J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
> (604) 793-9988 e-mail john.robertson@obgyn.net
> Who is wise and understanding among you? Let him show it by his good life,
> by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 20:41:00 +0530
> ------------------------------
> From: "Dr. Rupak Ranjan Roy" <rupakroy@vsnl.com>
> To: <ob-gyn-l@obgyn.net>
> Subject: Re: MgSO4
> Message-ID: <000401c0491a$ba62fa40$c06dc5cb@vsnl.net.in>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: 7bit
>
> There was also a review article in the July, 2000 issue of the British
> Journal of Obs. & Gynae about the prophylactic use of Mag sulph in severe
> pre-eclampsia. Concern was raised in the article about the long term safety
> of mag sulph. The references that were quoted were drawn from studies that
> dealt with its use as a tocolytic and did note slightly unfavourable
> outcomes in the Mag sulph group. So, this worry is not quite new.
> Sorry, I do not have a scanner, so I cannot post the article.
>
> Rupak Ranjan Roy
> MRCOG
>
>> ----- Original Message -----
> From: "Efrain Ramirez" <eramirez@icepr.com>
> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@forum.obgyn.net>
> Sent: 07 November 2000 07:12
> Subject: Re: MgSO4
>
> > Bob is right - there is an article on 8-00 Green -- cut-off dosis 48
> > grams - first time heard of it -
> >
> > At Mon, 6 Nov 2000, RModugno@aol.com wrote:
> > >
> > >--part1_38.d7fabd6.2738a08d_boundary
> > >Content-Type: text/plain; charset="US-ASCII"
> > >Content-Transfer-Encoding: 7bit
> > >
> > >In a message dated 11/6/00 10:22:51 AM Eastern Standard Time,
> > >perinatl@slip.net writes:
> > >
> > >> there are long term complications from the use of MgSO4 and
> > >> that its use in obstetrics should be stopped or significantly
> curtailed.
> > >> I was not at the meeting myself. This information that I am giving
> here
> > >> is puirely second hand and might not be totally accurate.
> > >>
> > >An article in the ?August 2000 Green Journal describes increased
> mortality in
> > >premature infants exposed to tocolytic doses of MGSO4. I believe their
> > >recommendation was to re-think its use in this context.
> > >
> > >Robert Modugno MD MBA FACOG
> > >Marietta, GA
> > >
> > >--part1_38.d7fabd6.2738a08d_boundary
> > >Content-Type: text/html; charset="US-ASCII"
> > >Content-Transfer-Encoding: 7bit
> > >
> > >In a message dated 11/6/00 10:22:51 AM Eastern Standard Time,
> perinatl@slip.net writes:
> > >
> > >there are long term complications from the use of MgSO4 and
> > >that its use in obstetrics should be stopped or significantly curtailed.
> > >I was not at the meeting myself. This information that I am giving here
> > >is puirely second hand and might not be totally accurate.
> > >
> > >An article in the ?August 2000 Green Journal describes increased
> mortality in premature infants exposed to tocolytic doses of MGSO4. I
> believe their recommendation was to re-think its use in this context.
> > >
> > >Robert Modugno MD MBA FACOG
> > >Marietta, GA
> > >
> > >--part1_38.d7fabd6.2738a08d_boundary--
> >
> > --
> > "Do not take life too seriously. You will never get out of it alive."
> >
> > Marianne Williamson
> >
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 18:26:01 -0600 (CST)
> ------------------------------
> From: islesannie@yahoo.com (Joanne Bulley)
> To: OB-GYN-L@OBGYN.NET
> Subject: Re: men and sections
> Message-ID: <200011080026.SAA03588@mail.medispecialty.com>
>
> Yeah, but what does it say when he practices right alongside his partner
> with such biased referral habits? - Does he confront her with the
> irrational nature of her medical referrals?
>
> Many docs find they have to agree more with partners than with spouses
> or significant others.
>
> Joanne
>
> At Tue, 7 Nov 2000, Braun, R. Daniel wrote:
> >
> > Yeah, and I was beginning to think (Infinitive, not split) that he was a
> >wimp at home.
> >Sure am relieved to hear that's not true.
> >
> >Dan
> >
>
> --
> Joanne Bulley, MD, FACOG
> Keene, NH, USA
>
> Take time to smell the roses.
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 18:50:41 -0600 (CST)
> ------------------------------
> From: eramirez@icepr.com (Efrain Ramirez)
> To: OB-GYN-L@OBGYN.NET
> Subject: Re: Depo a pro-coagulant?
> Message-ID: <200011080050.SAA07474@mail.medispecialty.com>
>
> Why is it that Danocrine or lupron is NOT an alternative?
> At Tue, 7 Nov 2000, John Robertson MD wrote:
> >
> >Just reading the comment, and anecdotally - there is a receptionist in a
> >GP office here in town who swears her severe asthma (several ICU
> >admissions) was drastically reduced once she started on Depo (used to be
> >in ICU on average once a year - hasn't had a significant respiratory
> >problem in 2 years). John
> >
> >At Mon, 6 Nov 2000, Robert J. Woolley wrote:
> >>
> >>In message <3A077331.17E8F449@mindspring.com> writes:
> >>>
> >>> Along the way, comprehensive evaluation for thrombophilia almost
> >>> certainly has been done.
> >>
> >>Yes. It's been narrowed down to a platelet disorder rather than a clotting
> >>factor disorder, but the university's hematologists aren't able to name a
> >>specific disorder.
> >>
> >>These results, as well as morbidity reported in
> >>> your note, might well cast grave doubt on probability of successful
> >>> outcome of pregnancy.
> >>
> >>She knows that. She also has severe asthma. She knows that it's unlikely that
> >>she'll ever be in a sufficient state of health to make pregnancy both safe and
> >>successful. But, understandably, she doesn't want to completely shut the door
> >>yet. Hope spring eternal. She's definitely not foolish enough to say that she's
> >>going to have a baby no matter what, but she also fears the later regret if her
> >>health should improve enough to make pregnancy possible in the future if only
> >>she hadn't had the endometrial ablation.
> >>
> >>--
> >>---------------------------------------------------------------------------
> >>
> >>---------------------------------------------------------------------------
> >>---------------------------------------------------------------------------
> >>---------------------------------------------------------------------------
> >>---------------------------------------------------------------------------
> >>---------------------------------------------------------------------------
> >>---------------------------------------------------------------------------
> >>Bob Woolley
> >>---------------------------------------------------------------------------
> >>St. Paul, Minnesota
> >>---------------------------------------------------------------------------
> >>---------------------------------------------------------------------------
> >>
> >>---------------------------------------------------------------------------
> >>GIC
> >>---------------------------------------------------------------------------
> >>
> >>---------------------------------------------------------------------------
> >>Marjorie Williams reported in the August 4 *Washington Post* that "In
> >>a recent poll by the Pew Research Center for the People and the Press,
> >>54 percent of those questioned said that Bush 'has relied on family
> >>connections to get ahead.'" The other 46 percent said that they had
> >>recently arrived from another planet.
> >>
> >> -- David Boaz
> >>
> >--
> >J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
> >(604) 793-9988 e-mail john.robertson@obgyn.net
> >Who is wise and understanding among you? Let him show it by his good life,
> >by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
> >
>
> --
> "Do not take life too seriously. You will never get out of it alive."
>
> Marianne Williamson
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 18:56:24 -0600 (CST)
> ------------------------------
> From: eramirez@icepr.com (Efrain Ramirez)
> To: OB-GYN-L@OBGYN.NET
> Subject: Re: men and sections
> Message-ID: <200011080056.SAA08459@mail.medispecialty.com>
>
> Enough said---either side--- let's goo into another "subject"
> --universal screening for pregnant wome for HSV...misoprostol for
> cervical ripening-
>
> At Tue, 7 Nov 2000, Joanne Bulley wrote:
> >
> >Yeah, but what does it say when he practices right alongside his partner
> >with such biased referral habits? - Does he confront her with the
> >irrational nature of her medical referrals?
> >
> >Many docs find they have to agree more with partners than with spouses
> >or significant others.
> >
> >Joanne
> >
> >At Tue, 7 Nov 2000, Braun, R. Daniel wrote:
> >>
> >> Yeah, and I was beginning to think (Infinitive, not split) that he was a
> >>wimp at home.
> >>Sure am relieved to hear that's not true.
> >>
> >>Dan
> >>
> >--
> >Joanne Bulley, MD, FACOG
> >Keene, NH, USA
> >
> >Take time to smell the roses.
> >
>
> --
> "Do not take life too seriously. You will never get out of it alive."
>
> Marianne Williamson
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 19:07:21 -0600 (CST)
> ------------------------------
> From: eramirez@icepr.com (Efrain Ramirez)
> To: OB-GYN-L@OBGYN.NET
> Subject: Re: Depo a pro-coagulant?
> Message-ID: <200011080107.TAA11330@mail.medispecialty.com>
>
> Yes or no -- is Danocrine -Lupron contraindicated in this patient???
> At Tue, 7 Nov 2000, Savaris wrote:
> >
> >Dear Bob
> >
> >> 1) The PDR actually says the contraindication is for women with a history
> >of
> >> "thromboembolic disorders." It seems to me that this means there has to be
> >a
> >> thromboembolism (e.g., to the lung), not just a thrombosis. Do you read it
> >the
> >> same way?
> >YES
> >
> >> 2) I'm not at all convinced that Depo has a pro-coagulant effect,
> >regardless of
> >> what contraindications the company's lawyers decided to put in the
> >prescribing
> >> info. Am I correct about that?
> >YES
> >> 3) It seems to me that these physicians, in recommending an invasive,
> >> irreversible, fertility-terminating procedure instead of at least a trial
> >of
> >> Depo, are putting their own fear of legal liability ahead of this
> >patient's
> >> interests. Does it seem that way to you?
> >YES
> >> 4) Would you prescribe Depo in this situation? If not, what alternative
> >would
> >> you think best?
> >YES, but other good alternative would be progestaset or Mirena
> >
> >Ricardo Savaris, MD, PhD
> >Porto Alegre - RS
> >Brazil
> >
> >"The things you learn after you know everything are the important ones"
>
> --
> "Do not take life too seriously. You will never get out of it alive."
>
> Marianne Williamson
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 19:11:49 -0600 (CST)
> ------------------------------
> From: eramirez@icepr.com (Efrain Ramirez)
> To: OB-GYN-L@OBGYN.NET
> Subject: Re: Depo a pro-coagulant?
> Message-ID: <200011080111.TAA12573@mail.medispecialty.com>
>
> Geff - I do not understand you assertion --- are you in favor of or
> against its use ?
>
> At Tue, 7 Nov 2000, Geffrey Klein, MD wrote:
> >
> >At 8:49 PM -0600 on 11/6/00, Robert J. Woolley wrote:
> >
> >>I have a 30-year-old friend (not a patient) who has had about 3
> >>spontaneous deep
> >>venous thromboses, the first while on oral contraceptives, the
> >>second two while
> >>off of them. Non-smoker. Now she is on Coumadin indefinitely. And she's have
> >>frequent, heavy menses, undoubtedly worsened by the Coumadin, and becoming
> >>anemic as a result.
> >>.......
> >
> >>3) It seems to me that these physicians, in recommending an invasive,
> >>irreversible, fertility-terminating procedure instead of at least a trial of
> >>Depo, are putting their own fear of legal liability ahead of this patient's
> >>interests. Does it seem that way to you?
> >
> >agree..
> >
> >>4) Would you prescribe Depo in this situation? If not, what alternative would
> >>you think best?
> >
> >I would give her depo after I explained the situation to her exactly
> >as you have presented it and had her sign informed consent (this is
> >overkill due to paranoia from med-mal liability but sometimes lawyers
> >make cases where the science does not support their contention)
> >
> >--
> >_______________________
> >Geffrey H. Klein, MD
> >_______________________
> >geffrey.klein@obgyn.net
> >200 Medical Center Blvd Suite 103
> >Webster, TX 77598
> >(281) 332 6723
> >
> >http://www.geffreyklein.com
> >
>
> --
> "Do not take life too seriously. You will never get out of it alive."
>
> Marianne Williamson
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 19:56:22 -0600 (CST)
> ------------------------------
> From: garrys@mindspring.com (Garry Siegel)
> To: OB-GYN-L@OBGYN.NET
> Subject: OB: AFP Triscreens in subsequent pregnancies
> Message-ID: <200011080156.TAA20986@mail.medispecialty.com>
>
> I'm doing a medline, but curious. Does anyone have any thoughts/data
> references regarding a question I was asked today.
>
> The patient said that since her AFP triscreens had been normal with her
> two prior pregnancies, does that make her chances of it being normal
> this time better/worse/no different?
>
> My gut says that each is an independent event, and that as she ages, the
> likelihood of an abnormal result with respect to Down sceening will be
> increased.
>
> Garry
>
> --
> Garry E. Siegel, M.D., F.A.C.O.G.
> Roswell, GA
> Private Practice
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 19:59:01 -0600 (CST)
> ------------------------------
> From: garrys@mindspring.com (Garry Siegel)
> To: OB-GYN-L@OBGYN.NET
> Subject: OB: Meconium/new resuscitation stuff
> Message-ID: <200011080159.TAA21501@mail.medispecialty.com>
>
> Today in our perinatal services meeting at the large hospital at which I
> practice, one of the neonatologist said that he just returned from a big
> meeting (oops--didn't ask him which one) and that the guidelines for
> meconium delivery evaluation/resuscitation had again changes.
>
> He said that the question to intubate or not should be based on the
> vigor of the baby, not on the thinness/thickness of the meconium.
> Apparently, this new guideline either is out in print, or will be.
>
> Any ideas as to where this is from/can be found?
>
> Garry
>
> --
> Garry E. Siegel, M.D., F.A.C.O.G.
> Roswell, GA
> Private Practice
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 20:03:43 -0600 (CST)
> ------------------------------
> From: garrys@mindspring.com (Garry Siegel)
> To: OB-GYN-L@OBGYN.NET
> Subject: OB: Placental Mosaism
> Message-ID: <200011080203.UAA22733@mail.medispecialty.com>
>
> Well, the next question tonight, and I'm doing a medline/looking at
> texts tomorrow in the office.
>
> A 40 YO gravida with a prior trisomy-13 found at 15 week amnio
> (terminated) now is 11 weeks, and contemplating CVS versus amnio. In
> her internet research, the issue of mosaicism found an CVS came up. The
> gist of her question was, "Why do a CVS that may lead me to need an
> amnio, rather than just do an amnio? The CVS has a higher loss rate."
>
> So, I wonder and am researching:
>
> How often is mosaicism found at CVS? Do we get percentages, i.e. 90% of
> the cells are 46 XX (or XY), and 10% are whatever?
>
> At what point do you need more info, i.e. an amnio or PUBS??
>
> How often is mosaicism found in term plancentas, or what percentage of
> cells (if any) are mosaic? What is the significance?
>
> Thanks
>
> Garry
>
> --
> Garry E. Siegel, M.D., F.A.C.O.G.
> Roswell, GA
> Private Practice
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 20:09:57 -0600 (CST)
> ------------------------------
> From: garrys@mindspring.com (Garry Siegel)
> To: OB-GYN-L@OBGYN.NET
> Subject: OB: Kidd JK(A) sensitization
> Message-ID: <200011080209.UAA24118@mail.medispecialty.com>
>
> 23 YO P2012, now at 10 weeks, found on initial prenatal panel to have a
> 1:4 antibody, Kidd JK(A). Her husband has fathered her two children and
> miscarriage (no D and C), and was tested an is antigen positive.
>
> So, she'll have serial titers, yada, yada.
>
> I'm looking online, but does anyone have any thoughts/reference on the
> frequency of Kidd antigen positivity/negativity in the population (this
> is US, caucasian)?
>
> Garry
>
> (BTW, the couple is young, together since age 16, very rural, and while
> nice/polite/churchgoer types, isn't among the leaders in RAM or hard
> drive space up top. That said, as I explained this, drew pictures, used
> analogies such an bee stings (antibodies and antigens), she seemed to
> get it, but kind of looked up and asked me, "Now why did you ask me if I
> was the father of the other pregnancies?" It was all I could do to keep
> a smirk off of my face.)
>
> --
> Garry E. Siegel, M.D., F.A.C.O.G.
> Roswell, GA
> Private Practice
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 20:31:49 -0600
> ------------------------------
> From: "Robert J. Woolley" <wooll005@tc.umn.edu>
> To: ob-gyn-l@obgyn.net
> Subject: Re: men and sections
> Message-ID: <iss.2b92.3a08bb14.c5fb0.1@garnet.tc.umn.edu>
>
> In message <200011080026.SAA03588@mail.medispecialty.com> writes:
> > Yeah, but what does it say when he practices right alongside his partner
> > with such biased referral habits? - Does he confront her with the
> > irrational nature of her medical referrals?
>
> Nope. I never knew about it until my wife told me. With my partners, I'm live
> and let live. I don't try to dictate how she does referrals, and trust that she
> won't try to dictate how I do mine. If she asked, I'd tell her my opinion, but I
> can't see any value in confronting her about it.
>
> --
> ---------------------------------------------------------------------------
>
> ---------------------------------------------------------------------------
> Bob Woolley
> ---------------------------------------------------------------------------
> St. Paul, Minnesota
>
> GIC
>
> Marjorie Williams reported in the August 4 *Washington Post* that "In
> a recent poll by the Pew Research Center for the People and the Press,
> 54 percent of those questioned said that Bush 'has relied on family
> connections to get ahead.'" The other 46 percent said that they had
> recently arrived from another planet.
>
> -- David Boaz
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 7 Nov 2000 20:36:25 -0600
> ------------------------------
> From: "Robert J. Woolley" <wooll005@tc.umn.edu>
> To: ob-gyn-l@obgyn.net
> Subject: Re: Depo a pro-coagulant?
> Message-ID: <iss.2cdb.3a08bc29.45552.1@garnet.tc.umn.edu>
>
> In message <200011080050.SAA07474@mail.medispecialty.com> writes:
> > Why is it that Danocrine or lupron is NOT an alternative?
>
> I don't know if they've been given consideration. The need for this to be
> long-term, possibly permanent, treatment makes them less attractive, though.
>
> --
> ---------------------------------------------------------------------------
>
> ---------------------------------------------------------------------------
> Bob Woolley
> ---------------------------------------------------------------------------
> St. Paul, Minnesota
>
> GIC
>
> Marjorie Williams reported in the August 4 *Washington Post* that "In
> a recent poll by the Pew Research Center for the People and the Press,
> 54 percent of those questioned said that Bush 'has relied on family
> connections to get ahead.'" The other 46 percent said that they had
> recently arrived from another planet.
>
> -- David Boaz
>
> ------------------------------
>
> ------------------------------
> Date: Tue, 07 Nov 2000 21:43:25 -0500
> ------------------------------
> From: Kathi Wilson <wilsonk@gtn.on.ca>
> To: ob-gyn-l@obgyn.net
> Subject: Re: OB: Meconium/new resuscitation stuff
> Message-ID: <3A08BDCD.48F529AB@gtn.on.ca>
> MIME-Version: 1.0
> Content-Type: text/plain; charset=us-ascii
> Content-Transfer-Encoding: 7bit
>
> Garry Siegel wrote:
>
> > Today in our perinatal services meeting at the large hospital at which I
> > practice, one of the neonatologist said that he just returned from a big
> > meeting (oops--didn't ask him which one) and that the guidelines for
> > meconium delivery evaluation/resuscitation had again changes.
> >
> > He said that the question to intubate or not should be based on the
> > vigor of the baby, not on the thinness/thickness of the meconium.
> > Apparently, this new guideline either is out in print, or will be.
> >
> > Any ideas as to where this is from/can be found?
>
> http://www.pediatrics.org/cgi/content/full/106/3/e29
>
> --
> Kathi Wilson, RM
> Ilderton, Ontario, Canada
> mailto:wilsonk@gtn.on.ca
> **********************
> Thames Valley Midwives
> 346 Platts Lane,
> London, Ontario, Canada
>
> http://tvm.on.ca
> mailto:info@tvm.on.ca
>
> ------------------------------
>
> ------------------------------
> Date: 07 Nov 2000 19:34:47 -0800
> ------------------------------
> From: Terrence Jones <Terrence.Jones@kp.org>
> To: ob-gyn-l <ob-gyn-l@forum.obgyn.net>
> Subject: Re: OB: Placental Mosaism
> Message-ID: <"0688F3A08C9D742E*/c=us/admd= /prmd=kp/o=notes/s=Jones/g=Terrence/"@MHS>
> Content-Identifier: 0688F3A08C9D742E
> Content-Return: Allowed
>
> Times like this we really miss Dr. Bui. Bet He had a hand in the EUCROMIC (Eur. Collab. Res. on Mosaicism in CVS) report (Pren Diag 1/99, 19:29-35). The general estimate of CPM in CVS is 1%. In 126,465 CVS samples studied, the occurrence of Trisomy 15 mosaicism was 0.027% (n= 34 Pts). This was true mosaicism in 1 Pt, indeterminate in 5, and CPM in 28. Of the 28 with confirmed CPM, there were 17 with information regarding site specificity. Restriction to cytotrophoblast was seen in 5 of 17 (29%) = Type 1. Restriction to extra-embryonic mesoderm (culture) see in 4/17 (24%) = Type 2. Involvement of both direct prep (cyto) and culture (EEM) was seen in 8/17 (47%) = Type 3. It's the Type 3 CPM that's assoc with a higher incidence of UPD (trisomic rescue is assoc with app 1/7 risk of maternal UPD). In the case of 15q11-13 (imprinted gene) this leads to Prader-Willi phenotype. Amnio can confirm eupoid fetus, and Your geneticist might offer ch 15 studies to r/o UPD on fetal fibroblas!
> !
> ts. The CVS merely confirms eupoidy earlier. If T-15 IS found, and amnio reveals euploid fetus with no UPD, then analysis of CPM suggestive of Type 3 might be assoc with placental-mediated poor pregnancy outcome(s). Hope this is a new paragraph (still haven't had time to read the lotus notes manual). Suppose it took a minute to bounce of 'Telestar", but the data on vigorous infants and mec suctioning goes back to 1992 - Katz & Bowes (AJOG 12/92) 167:1914-6). In utero asphyxia, leading to pulmonary vasospasm with subsequent endothelial cell damage will result, initially, in the decreased ability to clear mec from the airway. Persistence of this situation will lead to right-to-left shunt, pulm HTN, and inability to oxygenate. The mec is a marker, not necessarily a cause. For those infants that are non-vigorous, then clearing the airway (and adding surfactant, high-oscillatory ventilation, nitric oxide, or ECMO) may be of benefit. For those that are vigorous, the Cochrane analy!
> !
> sis of 4 randomized trials, by Halliday, showed no benefit in suctioning. tj.
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 08 Nov 2000 00:04:16 -0500
> ------------------------------
> From: Paul Prior MD <pprior@clover.net>
> To: ob-gyn-l@obgyn.net
> Subject: Re: OB: Placental Mosaism
> Message-ID: <2inh0tknnpsjmbaq3k3jf85o12kjdaml96@4ax.com>
> MIME-Version: 1.0
> Content-Type: text/plain; charset=us-ascii
> Content-Transfer-Encoding: 7bit
>
> On Tue, 7 Nov 2000 21:35:46 -0600, Terrence Jones
> <Terrence.Jones@kp.org> wrote:
>
> ..deleted...
>
> Great to see you back again, Terrence. I always take something away
> from your postings.
>
> The meconium debate has always seemed a bit irrelevant to me as if the
> baby is crying and active, meconium has already been moved into the
> airway- what value is there in tracheal suctioning?
>
> --
> Paul Prior MD Get rebates from online purchases - up to 30% cash back.
> Coshocton, OH Includes: Disney,Borders,Wine.com,800.com,Dell,petstore
> Solo Practice uBid,more.com,JCrew,800-flowers,Avon, WWF & hundreds more.
> OB/GYN Try: http://www.ebates.com/index.jhtml?referrer=pprior
>
> ------------------------------
>
> ------------------------------
> Date: Wed, 8 Nov 2000 07:04:17 -0500
> ------------------------------
> From: "K Dew" <kdew@bellsouth.net>
> To: <ob-gyn-l@obgyn.net>
> Subject: RE: AFP Triscreens in subsequent pregnancies
> Message-ID: <LOBBLHDGJEPNIJEICNFLEELDDJAA.kdew@bellsouth.net>
> MIME-Version: 1.0
> Content-Type: text/plain;
> charset="iso-8859-1"
> Content-Transfer-Encoding: 7bit
>
> go with your gut
>
> Kevin Dew, MD
> OB/GYN
> Bardstown, KY
>
> My gut says that each is an independent event, and that as she ages, the
> likelihood of an abnormal result with respect to Down sceening will be
> increased.
>
> ------------------------------
>
> ------------------------------
> End of OB-GYN-L Digest 1221
> ------------------------------
> ***************************
