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Re: 2 questions From: ri (savaris@orion.ufrgs.br) Thu Oct 10 12:02:39 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Chudacoff, MD: "Re: Puzzling case" Previous message: Braun, R. Daniel: "Re: Puzzling case" Maybe in reply to: Richard Chudacoff, MD: "2 questions" Next in thread: Efrain Ramirez: "Re: 2 questions" PROM case. I think that cerclage was a bit tempestive. PROM (or PPROM), is more likely to be due to infection. Before performing the cerclage infection should be excluded. She is almost 24 weeks, and depending the quality of your neonatal intensive care, it seems of little effective to place a cerclage in this patient. I would investigate infection, or start treating empirically with Ampicilin. There is a review on Cochrane this year suggesting the use of Erithromicin for PROM, but Ampicilin seems to be even better. If I am not wrong one of the doctors of our list has a nice review on cervical incompetence, with nice pictures. (Phillip Jeanty, if I am not wrong) That´s my opinion, hope it helps. -- Ricardo Savaris, MD your humble servant from Brazil > ----- Original Message ----- From: Richard Chudacoff, MD To: Multiple recipients of list OB-GYN-L Sent: Thursday, October 10, 2002 12:53 PM Subject: 2 questions 28 YO G2P0, with an 18 week loss secondary to PROM less than one year ago returned to my office at 22 weeks estimated gestational age. Her prenatal examination noted a slightly dilated external OS, and that weekend she had been tinged vaginal discharge. I reexamined her and her external OS seemed slightly more dilated, and therefore I put a cervical cerclage in her two days ago. Part of her preoperative evaluation I got a fetal fibronectin so I could have a baseline. Wouldn't you know it, but it came back positive. I have her on Indocin for 48 hours postop, but now what do I do? Second question: have you heard of this, and is anybody doing this in Houston? Tolerance-hyperbaric test (THT) that finds gestational hypertension and preeclampsia 23 weeks earlier than would be suspected clinically. Richard Chudacoff, MD, FACOG Chudacoff Obstetrics & Gynecology, PLLC 15200 Southwest Freeway, #270 Sugar Land, TX 77478 Tel: 281-277-3900 Fax: 281-277-3901 rchudacoff@mylinuxisp.com Richard.Chudacoff@obgyn.net http://www.mdhub.com/281-277-3900 http://www.chudacoffobgyn.yourmd.com ********************************************************************** Neither the confidentiality nor the integrity of this message=20 can be guaranteed following transmission on the Internet. ********************************************************************** =20 Next message: Richard Chudacoff, MD: "Re: Puzzling case" Previous message: Braun, R. Daniel: "Re: Puzzling case" Maybe in reply to: Richard Chudacoff, MD: "2 questions" Next in thread: Efrain Ramirez: "Re: 2 questions"

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