Re: 32 week PROM Recent Herpes outbreak Help
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Mon Jan 17 18:58:45 2005
I play that game, too.
I also use it to discuss cases with our CNMs, i.e. Ms. CNM, why did
you give this woman antibiotics for GBS when she was at term, unknown
GBS status, and no risk factor (had that discussion today)?
Do you know more than the CDC and ACOG?
Garry
At Mon, 17 Jan 2005, Richard Chudacoff, MD wrote:
>
>Well, I always play the testimony game: what am I going to say to the
>attorney representing the patient if I get sued:
>
>"So, Doctor. Your MFM consult recommended immediate c-section and you chose
>to wait, and the baby developed herpetic encephalitis. What where you
>thinking of, with your general training background?"
>
>I suppose that in this case since they are the expert consultants I would
>follow their advice. You did ask for their advice despite the fact that you
>might have received expectant management advice from another MFM.
>
>--
>Richard Chudacoff, MD
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew
>Sent: Monday, January 17, 2005 4:56 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: 32 week PROM Recent Herpes outbreak Help
>
>At Mon, 17 Jan 2005, art fougner, md wrote:
>>No prodromal symptoms. I agree and that was my plan of action as well.
>MFMs recommended primary section due to "risk of herpes shedding" and
>potential for herpes encephalitis.
>>Any prodrome?
>>
>>art
>>
>>At Mon, 17 Jan 2005, Efrain Ramirez wrote:
>>>
>>>Agree with Richard - antibiotics, Valtex, steroids/tocolytics - for 48
>>>hours -- wait- reevaluate..
>>>
>>>> At Mon, 17 Jan 2005, Richard Chudacoff, MD wrote:
>>>>
>>>>Interesting cases you have. No current outbreak, I'd place her on
>>>>prophylactic Valtrex, treat with antibiotics for a week and steroids for
>48
>>>>ours. I'd like to get 48 hours of out her, but if cultures come back
>>>>negative, then I'd wait until she tips her hand
>>>>
>>>>--
>>>>Richard Chudacoff, MD
>>>>
>>>>-----Original Message-----
>>>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew
>>>>Sent: Monday, January 17, 2005 8:19 AM
>>>>To: Multiple recipients of list OB-GYN-L
>>>>Subject: 32 week PROM Recent Herpes outbreak Help
>>>>
>>>>Please give me your thoughs on the following: 32 week 5 day G1P0 comes
>>>>in with PROM. Recurrent herpes outbreak on vulva treated two weeks agow
>>>>with PO valtrex. No prodromal symptoms or active lesions now. Cx 1 cm
>>>>25%. Do you go to primary section for recent herpes outbreak?? Do you
>>>>give steroids and wait 48 hours and induce? Give IV Valtrex and no
>>>>steroids and wait? Any role for HSV titers or culture?
>>>>
>>>--
>>>"The opposite of a correct statement is a false statement.
>>>But the opposite of a profound truth may well be another profound truth."
>>>
>>>Niels Bohr (1885 - 1962)
>>>
>>--
>>art fougner, md
>>
>> "If you don't know where you are going, you will wind up somewhere else."
>>Lawrence Peter Berra
>>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
