Re: OB: Fun with preeclampsia--very long!
From: Garry Siegel (garrys@mindspring.com)
Sun Jul 29 21:59:17 2001
I will not have easy access to the chart, and once they are discharged,
I don't think that I can get a computer printout of the labs, but I'll
find out what the PP platelets and SGOT were (if my partner ordered
those tests!). If I don't get these values Monday or Tuesday, within a
few days I'll see the chart at medical records, and get the info.
Luis, give me a break on the BPs--she clearly had enough systolics over
140 and diastolics over 90 to meet the 140 or 90 criteria.
Her urine in the office, voided, had no or trace protein. I don't know
that it was checked again, and I'm not sure that it needed to be.
Serial chemistry panels and CBCs, for the third time, were stable
throughout here antepartum course.
Luis--pretend I'm Regis Philbin, and this is for one million dollars.
Based on what you've heard, her diagnosis is:
1. Severe Pre-eclampsia
2. Gestational thromobcytopenia
3. Hemolytic uremic syndrome
4. ITP
Garry :)
>
>Garry:
>
>I think we need more detailed information. I know You were not the only
>physician taking care of the patient and that you do not remember all of
>the lab values and blood pressures that were done while you were her
>managing physicisian. However, I am sure you have access to her medical
>chart. Please let us know from her intrapartum flow sheet what the
>blood pressures were (mean, mode median)I don't think its sufficient to
>say that 120 to 160 over 80 to 95 are the values that *you remember*.
>There is no reason you couldn't obtain the documented data from the
>chart. Similarly, I'm sure that this patient had serial lab tests
>performed (LSTs and CBCs)I'm sure that you can obtain a computer
>read-out and inform us of the results (of all the tests performed:
>inatrapartum and postpartum). Lastly, did you and other members of your
>group obtain only a single dipstick reading for the assessment of
>proteinuria? If not, please let us know the results of the other urinary
>samples.
>What was her final diagnosis? I would not be surprised if she did have
>preeclampsia however, since you presented this case and it has generated
>so much discussion, I think it is necessary to come up with a diagnosis;
>for that to occur we need as much data as you can provide.
>
>If we conclude that the patient did not have preeclampsia, would you
>still justify the induction? No doubt, if she did have preeclampsia
>(mild or severe) induction of labor was definitely indicated. A 24 hour
>urine would have been of help if the data obtained was not conclusive on
>the first day. Certainly the excretion of total protein and calcium
>would be helpful in making a possible diagnosis.
>Thanks in advance for looking up all these values for us.
>
>Luis
>
>At Sun, 29 Jul 2001, Garry Siegel wrote:
>>
>>>From the original post:
>>
>>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
>>
>>>Come on Garry, give us all the information so that we can put this case
>>>to rest. I am sure, as Dr. Woolley states, that this patient had many
>>>BPs taken during her prolonged labor induction. Similarly, serial
>>>laboratory tests were likely performed. Give us the following
>>>information:
>>>(1)BP readings during labor (mean, mode median) for systolic and
>>>diastolic BPs).
>>
>>120 to 160/80 to 95 are the numbers I remember over 48 hours.
>>
>>>(2)serial platelet counts
>>
>>90K to 100K antepartum; I was not the on call doc after delivery so I
>>don't know what it went to PP.
>>
>>>(3) urinary dipstick results
>>
>>Oops--I must have forgotten to say in the original post. No
>>proteinuria.
>>
>>>(4) LFTs (SGOT, AST, LDH)
>>
>>As stated above, SGOT normal--it was 30, and the upper normal in our lab
>>was 35 or 40 (can't remember at that hospital).
>>
>>LDH--normal, I think. AST--isn't that another name for SGOT, Luis?
>>
>>Garry
>>
>>>At least with these results we all can come to a conclusion whether or
>>>not the patient had preclampsia (mild or severe)HELLP syndrome.
>>>
>>>Thanks
>>>
>>>LSanchez-Ramos
>>
>>--
>>Garry E. Siegel, M.D., F.A.C.O.G.
>>Roswell, GA
>>Private Practice
>>
--
Garry E. Siegel, M.D., F.A.C.O.G.
Roswell, GA
Private Practice
