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Re: 32 week PROM Recent Herpes outbreak Help From: Braun, R. Daniel (rbraun@iupui.edu) Tue Jan 18 09:36:06 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Henry Gregor: "Re: Gyn: Premature Menopause (surgical) and Bioidentical hormones" Previous message: Henry Gregor: "Re: 32 week PROM Recent Herpes outbreak Help" Maybe in reply to: Andrew: "32 week PROM Recent Herpes outbreak Help" R. Daniel Braun, MD "If everyone likes you, you're doing something wrong." Kinky Friedman I believe a self-righteous liberal or conservative with a cause is more dangerous than a Hell's Angel with an attitude. Andy Rooney -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Henry Gregor Sent: Tuesday, January 18, 2005 11:29 AM To: Multiple recipients of list OB-GYN-L Subject: Re: 32 week PROM Recent Herpes outbreak Help F/u observation..if MFM advises c/s for prom w/herspes (inactive re lesions, unknown re cx'l viral shedding status)...has the window of opportunity for c/s benefit nonetheless closed....ie, how many hours had gone by with rom b4 the c/s recommendation had been given? No such thing. C/S always ends up with a lower level of colonization than if the baby goes through the birth canal. So there is always lower level of colonization, if the virus is present, just not as much as if done in less than 4 hours which is supposed to be 0 colonization(But I doubt that too) Dan Also, asking for a consultant opinion is not equivalent to accepting the recommendation and may only be a springboard for additional input to evaluate issues raised by the consultant's report. Hank Efrain Ramirez <eramirezt@coqui.net> wrote: 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) _____ Next message: Henry Gregor: "Re: Gyn: Premature Menopause (surgical) and Bioidentical hormones" Previous message: Henry Gregor: "Re: 32 week PROM Recent Herpes outbreak Help" Maybe in reply to: Andrew: "32 week PROM Recent Herpes outbreak Help"

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