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Re: OB: Fun with preeclampsia--very long!From: Joe Cutchin (forcep@intercom.net)Fri Jul 27 20:24:43 2001
John Robertson MD wrote: > > Kathi brings a very good point to the discussion, and a strong reason > why I am not on the side of Bob and Steve. I too have seen atypical > presentations of Pre eclampsia/PIH/HELLP. Part of the reason why I > think we have so many names for it is that it has so many variations in > the presentation. The point that Kathi mentions is (part a) how quickly > it can change and (part b) that they can be sick (and even get sicker) > for a good time after they have delivered. If the platelets are > dropping as you deliver, they will not necessarily recover immediately > after you deliver, and you can be in worse trouble a day or two later. > John. > > At Fri, 27 Jul 2001, Kathi Wilson wrote: > snip > > > >The sickest client with HELLP that I, personally, have been involved with was a > >woman who presented at 37 weeks w/ "heartburn" that persisted throughout the day > >despite using remedies. She resisted being assessed at the hospital because she > >thought we were overreacting. Her BP was 130/90 on assessment, a mild but not > >significant elevation for her. No proteinuria. > > > >Interestingly, the consultant on call (a newbie, actually) only ordered a CBC > >(which I bet she *never* does again), which demonstrated a *very* mild > >thrombocytopenia of 121 K. She wanted to send the woman home. My midwife partner > >stood her ground and said "uh, uh, she's not going home until we do some liver > >functions". Ta, da. Mildly elevated AST and ALT. > > > >Over the next ten hours, her platelets went from 121 to 40, her LFT's soared, and > >her BP really didn't go up any more than it had been at presentation. Unlike the > >usual PIH presentation, she didn't respond to induction at all, and was sectioned > >before she got any sicker. She was transfused w/ 9 units of platelets (4 > >initially, and then another five, and they continued to drop after transfusion). > >(I shudder to think what would have happened if she'd been sent home....) She > >ended up w/ all the "letters" in HELLP. Hgb postpartum fell to about 70, bili > >quite elevated. Got quite a bit sicker pp before she started to get well. > > > >This is a disease w/ many end organ manifestations. Proteinuria is only one of > >them, and may not ever appear. I have a *very* healthy respect for anything that > >even faintly sniffs funny w/ PIH, and epigastric pain in pregnant women makes me > >twitch something awful. > > > >BTW, w/ a severe pre-eclamptic, our guys put in a foley *and* start oxytocin > >simultaneously. This was the first time I had not seen it work. > > > >-- > >Kathi Wilson, RM > >Ilderton, Ontario, Canada > >mailto:wilsonk@gtn.on.ca > >********************** > >Thames Valley Midwives > >**********************
> >346 Platts Lane, Good points, John. The other unusual feature is "they don't appear" ill ..
--
Joseph H. Cutchin MD FACOG 4105463125
314 West Carroll Street 4105463128 Fax
Salisbury,Maryland 21801
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