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Re: OB: Fun with preeclampsia--very long!From: Robert Woolley (wooll005@tc.umn.edu)Sun Jul 29 08:43:13 2001
> Bob, I am curious about one point. All during this debate, you apparently > seem to be claiming that Garry's patient did not have hypertension. Garry > tells us that her diastolic in the office was 90 X 2 and remained in the > 90's in labour and delivery (and that this was an elevation of 20 over > baseline). Since the NIH definition is 140 systolic OR 90 diastolic, No, it says that it must be *over* 140 systolic or 90 diastolic. And as has been pointed out, we've only been given this one reading. It's likely that the bp was taken many times per day over this 3-day period. It's not very likely that it went higher without Garry mentioning that fact.
> I did not say that.
In our institution, plts are
> usually done q 4 - 6h in such a situation. In 6 h, her plts could have Right. Of course, that's also true for somebody who goes into labor with platelets of 200K. So, following your logic, we should assume that every patient is about to drop her platelets, so we have to intervene now.
I know that in my institution, the obstetrician
> consultants would also have induced this woman, not hedge their bets and I was always taught that one needed to make a diagnosis before instituting treatment. Silly me.
Sections
> on a woman w/ severe thrombocytopenia are *not* a pretty sight, as I'm Right. So again, we'd better just do sections on every patient, since any of them might suddenly become thrombocytopenic.
> Right. So why are you supporting intervention for preeclampsia when it is "unclear" whether she had it? Would you recommend mastectomy and chemotherapy for a patient if you were "unclear" whether she had breast cancer?
> Consensus is not very persuasive to me.
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