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Re: 34 week prom From: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net) Fri Apr 8 14:03:07 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: SOS Bakri Tamponade Ballon" Previous message: Efrain Ramirez: "Re: Gyn: Granulation post hyst" In reply to: Andrew Folley: "Re: 34 week prom" Next in thread: Andrew Folley: "Re: 34 week prom" Reply: Andrew Folley: "Re: 34 week prom" This issue has been addressed with several abstracts over the past two years at the Society meeting. Because of the increased incidence of neurodevelopmental issues associated with children who are products of PPROM over controls with just prematurity, the effects of various inflammatory markers (i.e. cytokines, metalloproteinase's, interlukins)have been looked at. Granted, some of these studies are animal models, but exposure of brain tissue to these substances has impressive effects. Because these factors are produced prior to clinical evidence of infection, and thus the potential untoward effects on the fetus, it has been suggested to move the point at which you electively deliver, with PPROM, earlier that what I was taught at 36 weeks. Data is pretty conclusive that 34 weeks is the more prudent timing - issues regarding prematurity are outweighed by the risk of neurodevelopmental issues - and the fact that the ultimate outcome of pregnancies beyond 34 weeks is the same. One paper actually goes as far as suggesting that 32 weeks is the more prudent "end-point" in PPROM. I haven't yet been convinced to go that far. A year ago at the Society meeting, because of what these various papers suggested, I polled several programs represented, asking them what their policy was with regard to timing of delivery with PPROM and the predominate answer was 34 weeks. Lynn -- Lynn D. Montgomery, M.D. Maternal-Fetal Medicine, OB/GYN Rocky Mountain Women's Health 2835 Fort Missoula Rd., Suite 304 Missoula, Montana, 59804 406-549-0978 fax 406-549-0987 e-mail: apgar10@montanadsl.net -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew Folley Sent: Thursday, April 07, 2005 10:16 AM To: Multiple recipients of list OB-GYN-L Subject: Re: 34 week prom Question: Had a patient show up last night G3P2 ruptured membranes 34 weeks 1 day. 2 prior c-sections. Not in Labor. What to do? She is vertex fluid in vault sent for f-pole showed not mature. My plan was steroids, tocolysis for 48 hours if necessary and repeat c-section in 48 hours. Along with GBS prophylaxis. Some of our MFMs were not so happy with the management plan. What ywoud you do???? andy > Next message: art fougner, md: "Re: SOS Bakri Tamponade Ballon" Previous message: Efrain Ramirez: "Re: Gyn: Granulation post hyst" In reply to: Andrew Folley: "Re: 34 week prom" Next in thread: Andrew Folley: "Re: 34 week prom" Reply: Andrew Folley: "Re: 34 week prom"

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