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Re: preterm ROMFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Mar 10 14:50:40 2004
Stop Terb. If she is contracting it, may well be a sign of infection(amnionitis). Why did the membranes rupture?? Chorioamnionitis??? If so delivery is best. What is the outcome in your nursery for a 32+4 Non infected baby with >24 hrs of Steroids versus a 33 weeker with severe infection?? In our nursery, it is about 96% vs 50%, respectively. Carefully monitor for any Sign of Infection (Fetal tachycardia{an increase in baseline FHR of >10 BPM}, fever, uterine tenderness, contractions, elevation of WBC's{May be present already due to steroids}, We used to look for an increase in CRP, but it is worthless) We get a 10 minute FHR strip Q shift in these patients to look fo rthe increase in baseline FHR. If the exam this AM was after ROM, there is a real good chance that she will go into labor within 48 hours and solve the problem. Dan "Sound is like water. If you drill one hole in the wall the sound will leak right through." - JAY BRAUN, a band member by love, a soundproofer by necessity. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Wednesday, March 10, 2004 3:19 PM To: Multiple recipients of list OB-GYN-L Subject: preterm ROM Dang, it has been a couple of years since I had one of these. 27 yo G3 P2 at 32+4 weeks EGA, admitted 36 hours ago with PTL. Stopped with Terbutaline. Finished Dexamethasone this morning, has been on Ampicillin since admission, as well as Macrobid for a presumptive UTI picked up a day earlier. Cervix at admission was 70%/3-4 cm/-2, and this AM 40%/1-2/way up high. Already to go home to bed rest, then she SROMs. No question of her staying in the house now, but do I add another antibiotic? Do I keep her on Terbutaline (which can mask HR elevation?) Oh ya, her husband is an MD, so you KNOW this was going to happen Richard Chudacoff, MD [We stand] today poised on a pinnacle of wealth and power, yet we live in a land of vanishing beauty, of increasing ugliness, of shrinking open space and of an overall environment that is diminished daily by pollution and noise and blight. This, in brief, is the quiet conservation crisis. Stewart L. Udall <http://www.brainyquote.com/quotes/quotes/s/stewartlu112379.html>
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