Re: 34 week prom
From: Andrew Folley (agfolley@hotmail.com)
Fri Apr 8 15:55:59 2005
Lynn thanks for such a clear anc concise response. Over the past yar I have
been pushing for giving steroids antibiotics and tocolysis for PPROM at
32-34 weeks and cytokine release etc and role in causing cerebral palsy. Do
you think that is too aggressive at this point??? andy
>From: "Lynn D. Montgomery, M.D." <apgar10@montanadsl.net>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: RE: 34 week prom Date: Fri, 8 Apr 2005 14:04:10 -0500
>
>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
>
> >
>
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