Re: 32 week PROM Recent Herpes outbreak Help
From: Efrain Ramirez (eramirezt@coqui.net)
Mon Jan 17 19:16:07 2005
Your concerns..
>At Mon, 17 Jan 2005, Garry E. Siegel, M.D. wrote:
>
>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
>
--
"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)
