|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
FOR DR. RUPAK RANJAN ROYFrom: Anu (avni@vsnl.com)Mon Jul 30 00:04:57 2001
dear dr. rupak roy, ur email id rupakroy@vsnl.com is not working. do let me know any other alternate email id...till then i am sending the mail here.please excuse for the lengthy mail. hello dr. rupak roy, i am very grateful to u for ur prompt reply to the query i posted on ob.gyn.net regarding polyhydramnios, role of indomethacin in treatment etc. well, i must apologise to u for not replying back immediately. well this is because i had a caesarean section on the 12th of this very month and my baby expired on the 15th of this very month, so i was recuperating and not accessing the internet too much. sometime back i logged in and was happy to see a few replies to my query. well, i am from mumbai, stay in borivali. so had chosen a local gynaec and went into PROM, so had to go in to her only and could not go to BOMBAY Hospital, Hinduja etc. i enquired about a good NICU and was told that Nanavati was good enough, but it seems that we made a wrong choice. i was lying in a different nursing home after a c-section and my hubby and in laws were running to Nanavati, which is near Juhu for the baby. So it was a bit of mismanagement. when i started having polyhydramnios, i reported to my gynaec as well as consulted 4 of my gynaec friends, but no one advised me for anything except bedrest. indomethacin was out of question as no one had ever used it in practise. therapeutic amniocentesis is not done routinely here. i presume u are from calcutta, do they do therapeutic amnios routinely there? i guess not. do u have any inputs on prevention of hydramnios and the incidence of its recurrence? also any genetic markers to know about respiratory development esp the surfactant development of the foetus? i had the triple maternal screen done...it was normal. u asked me about 2 doses of steroids? yes , they were given but cud wait only for 24 hours after the last dose as the foetal heart rate became irregular and induction by oxytocin failed. so they had to do a C- section. also, the baby was kept only two days in the NICU,and taken out to the ward third day with the excuse that a better ventilator was there...and they had to put it on a ventilator. this was something i very much resented and opposed but was of no use.he had polycythaemia too and was given plasma transfusion twice.basically the most important problem was poor development of surfactant. but they had ruled out hyaline membrane disease. ther was an element of aspiration pneumonia too. the fourth morning, the baby suddenly collapsed. presumably due to brain haemorrhage, due to the high oxygen therapy. well, thats all...i am sorry for this very lengthy mail. but i need to share with a good gynaecologist all the details. i request u to give me ur valuable advice. the sad part of this is that i am myself a doctor and this was a precious child conceived after 7 years of marriage.tho' i had a laparoscopy done 2 years earlier and everything was normal. this baby had conceived naturally.but we were destined not to have it. u asked about indomethacin....i am attaching the reply i got to it in my personal email...this reply is very informative and will answer all ur queries. several issues to address; I. serial amniocentesis is a proven method of reduction of AFV that we use routinely, when indicated. the difficulty is in determining when to begin. suffice it to say that this therapy is well tolerated. in a recent case we removed in excess of 10 liters over several sessions. this definately can be done II. I have no evidence concerning dietary manipulation to control afv. it strikes me that this must be very difficult to judge and i would not count on this type of treatment for anything but a minimal and perhaps not measurable benefit
III. Indomethacin can be used successfully and the
risk is not
in stillborn. the prostaglandin inhibitors
interfere with fluid production
by the fetal kidney, thus reducing volume. we
generally start with
50 mg then treat with 25 mg q 6 hours for a total of
48 hours, repeat
i ing the sequence after a rest of 48 hours as often
as needed to
control fluid volume. other agents may also be used
but none
is as effective as indocin and to get the same
effect, the others
must be pushed in dose, likely resulting in the same
possible
side effects as indocin. indocin should not be used
after 32 weeks
and, in our experience, should be used
intermittently, as suggested.
a posssible side effect of indocin is ductal closure
but this is dose
dependent
> the I was having some technical difficulty with my system keyboard. The only item I might add is that AFV definately can be controlled but it requires active intervention and treatment BEFORE the volume is so severe as to result in marked uterine activity/ preterm labor. To wait until symptoms are acute is a proper prescription for failure. The time to intervene is when the volume is observed to increase and just begin to result in recurrent uterine activity -- the latter is best judged by occasional tracing with the toco--some of this is below the threshold of the gravida. As you are aware, your chance of recurrent , idiopathic hydramnios is quite low, so much of this is unlikely to be of clinical consequence to you. Thus, do not lose heart ! jpogrady md thanks rupak again for replying to my mail. request you to bear with this lengthy reply and reply me again. hopefully u r from kolkatta, have a colleague working in Birla hospital. my hubby's family also stayed in Alipore for 18 years and all speak fluent bengali. so i am happy that a bengali doc replied to me! wish u happiness and a lot of success. regards, dr. anuradha singh avni@bom5.vsnl.net.in
|
|
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.