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Re: OB: Fun with preeclampsia--very long!From: Joe Cutchin (forcep@intercom.net)Fri Jul 27 15:54:24 2001
Robert Woolley wrote: > > > From: garrys@mindspring.com (Garry Siegel) > > Reply-To: ob-gyn-l@obgyn.net > > Date: Thu, 26 Jul 2001 21:50:06 -0500 > > To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.medispecialty.com> > > Subject: OB: Fun with preeclampsia--very long! > > > > 33 YO P0, infertility patient, now at 38 weeks sees my partner for a > > routine visit. > > > > Day One > > 11 AM: BP 120/90, no increased weight or proteinuria, normal edema for a > > 38 weeker, but BP up a bit over baseline from early pregnancy. Cervix > > 0/25%/firm/high/posterior/rotten. EFW clinically 2500g, vertex. > > Sent to L and D for blood, NST, a few BP checks. > > > > 1 PM: SGOT normal, creatinine 1.1 (elevated for pregnancy), platelets > > 95K. Diagnosis of severe preeclampsia by virtue of thrombocytopenia. > > 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? > > > > > 11 AM: Deliveries healthy baby vaginally by partner. Asks partner why > > she has to stay on mag for 24 hours! > > > > Garry > > OK, so when did you see the proteinuria in order to diagnose preeclampsia, > so that you can at least retrospectively justify all those apparently > unnecessary interventions? From your description, she never had hypertension > and never had proteinuria. Sounds like you put her through a whole truckload > of stuff in order to treat...what? Mild thrombocytopenia? When did Cytotec > and/or Pit and/or c-section become indicated to treat thrombocytopenia? Robert: you obviously have not had the priviledge to see a platelet count go from 100K to 20K in a short period of time, without proteinuria.
--
Joseph H. Cutchin MD FACOG 4105463125
314 West Carroll Street 4105463128 Fax
Salisbury,Maryland 21801
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