Re: OB: Fun with preeclampsia--very long!
From: Charlie Chambers (cchamber@alumni.rice.edu)
Fri Jul 27 12:49:48 2001
on 7/27/01 10:32 AM, Garry Siegel at garrys@mindspring.com wrote:
>>>
>>> Well, we've got a problem already. You're diagnosing her with "severe
>>> preeclampsia" when you've found that she has no proteinuria. Please explain.
>>> What diagnostic criteria do you use?
>>
>> Bob, severe pre-eclampsia can certainly occur in the absence of
>> proteinuria. Been there, done that. Variant of HELLP basically.
>> Having said that, I am interested to see that someone diagnosed with
>> "severe" preeclampsia was managed over a 3 day period. My goal is to
>> get those patients delivered within 24 hours of diagnosis. I
>> understand that this was somewhat of a "soft" call, but once the
>> diagnosis is on the chart....
>>
>> Was a foley bulb considered? I have found that an excellent adjunct
>> to cytotec, when there are too many contractions to give a 2nd dose.
>
>>
> Paul, you are my knight in shining armor to reply to Bob. I did not
> make the distinction between Pre-eclampsia and Gestational Hypertension
> and Pregnancy Induced hypertension, since I never can get them straight,
> and, most important in this case, *it didn't matter*. Bob, sorry to be
> argumentative and not scientific, but in this case, you gotta be
> practicing Ob--I think that all of us would agree that delivery was
> warranted.
>
> With respect to using a foley, I didn't grow up using them, and thus, it
> didn't hit my radar scope. I will think about it next time, but I'm not
> sure that this woman would have tolerated it. Can you put it in a
> closed cervix? Would you ever place an epidural first?
>
> Paul, I am not aware of there being an arbitrary time limit in severe
> pre-eclampsia. A staged ripening/induction like this isn't so common
> anymore, but still OK, I think. Obviously, had her pressures been bad,
> requiring apressoline (they didn't), her output diminshed, or her labs
> getting worse, then I would have been more anxious to section her. As
> it was, I was ready to section her just to put us all out of our misery!
>
> I bet that her SGOT will go up post partum!
>
> Garry
>
> --
> Garry E. Siegel, M.D., F.A.C.O.G.
> Roswell, GA
> Private Practice
we had occassion to use the foley ballon in residency. Seem to have good
success, primarily with cervical dilation not effacement. However, use was
put on hold because of a couple of significant intrauterine infections.
Anyone else have this experience?
--
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Charlie Chambers
Hood River, OR USA
cchamber@alumni.rice.edu
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