-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: OB: Fun with preeclampsia--very long! From: Kathi Wilson (wilsonk@gtn.on.ca) Sun Jul 29 21:01:55 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Kathi Wilson: "Re: OB: Fun with preeclampsia--very long!" Previous message: art fougner, md: "Re: Medical decision-making" Maybe in reply to: Garry Siegel: "OB: Fun with preeclampsia--very long!" Next in thread: Robert Woolley: "Re: OB: Fun with preeclampsia--very long!" Reply: Robert Woolley: "Re: OB: Fun with preeclampsia--very long!" Robert Woolley wrote: > 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. Actually, Garry has already posted that her diastolics were "in the 90's" subsequent to the office readings. So, if she's 91 diastolic, she's hypertensive, but if she's 90 she's not? Spare me. Nobody's ears are good enough to make the distinction (and dynamaps are not always reliable, either). I think, however, we've already established that women can have HELLP syndrome w/ minimally elevated BP's, in any case. This woman had a 20 mmHg rise in BP, which, although the experts say that it doesn't matter, usually raises a bit of a red flag for those of us who provide care to pregnant women. > > Additionally, with respect to your comment that nothing should have been > > done until another platelet count was done. > > I did not say that. Sorry, then, I misinterpreted. What you said was: "OK, so again it sounds like you *are* saying that 90K platelets means you should at least intervene as if the patient has preeclampsia, even if you don't actually diagnose it. Is that correct? I see no other conclusion, since you way one shouldn't wait to see what the next plt count it." I read that as meaning you *would* wait until the next platelet count before intervening. > In our institution, plts are > > usually done q 4 - 6h in such a situation. In 6 h, her plts could have > > been, oh, 50K. > > 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. Excuse me? This woman already *has* a thrombocytopenia, albeit not yet severe. There's a bit of a difference, really. Trust me, Bob, I went to school in Hamilton, I know who Bob Burrows is, and I know about gestational thrombocytopenia. (Actually, the interesting thing to me is that Garry's woman had an epidural. In our hospital, the gas-passers wouldn't have given her one -- 100K is their cut-off for epidural). > I know that in my institution, the obstetrician > > consultants would also have induced this woman, not hedge their bets and > > hope that she doesn't become sicker before making a diagnosis. > > I was always taught that one needed to make a diagnosis before instituting > treatment. Silly me. I'll let our MFM guys know that you think they're full of s**t, Bob. Although they don't know you from Adam, I'm sure they'll be impressed with your correction of their mistakes and mend their ways. > Sections > > on a woman w/ severe thrombocytopenia are *not* a pretty sight, as I'm > > sure many would agree. > > Right. So again, we'd better just do sections on every patient, since any of > them might suddenly become thrombocytopenic. I guess I should ask what your definition of thrombocytopenia is, too, Bob. I was always under the impression (as are our anaethesia people) that 95 K *was* thrombocytopenia. Silly me. I (and we) stand corrected. I shall let our anaesthesia people know they're wrong. > > I think there are two issues here: > > > > 1. Did this woman have severe pre-eclampsia or the beginning of HELLP > > syndrome? The answer appears to be unclear, according to the many > > experienced OB's who have debated the issue. > > 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? Bob, because, unlike w/ breast cancer, you actually usually have some time to deal with making a diagnosis before the woman does something bad, like seize, abrupt or just plain die. Pre-eclampsia and its sequelae are, in a developed nation like Canada, still the 4th leading cause of maternal death in Ontario. People are understandable extremely respectful of the damage it can do. I suppose you won't believe me about another woman I looked after who had pressures of 130/80 (from baseline 110/60 early preg) in labour, and 90K platelets. LFT's were fine. Had a PIH style labour -- blew the kid out. The next day, postpartum, her pressures went to 170/110. But, really, there wasn't a thing wrong with her, eh? > > > > 2. Should she have been induced when she was? The consensus appears to > > be "yes", > > Consensus is not very persuasive to me. I feel like I'm pissing in the wind here, anyway, but the point to me is that those of us who actually *do* provide care to pregnant and labouring women have all had scary experiences w/ women who have presented like the woman Garry had...even me, and I'm supposed to be looking after low-risk women. Unfortunately, PIH/Preeclampsia/HELLP doesn't always follow the rules of engagement. -- 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 Next message: Kathi Wilson: "Re: OB: Fun with preeclampsia--very long!" Previous message: art fougner, md: "Re: Medical decision-making" Maybe in reply to: Garry Siegel: "OB: Fun with preeclampsia--very long!" Next in thread: Robert Woolley: "Re: OB: Fun with preeclampsia--very long!" Reply: Robert Woolley: "Re: OB: Fun with preeclampsia--very long!"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 04:49:24 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.