OB-GYN-L Messages for August, 2005: Re: pprom and antibiotics

Re: pprom and antibiotics

From: Lynn D. Montgomery, M.D.

apgar10@montanadsl.net

Wed Aug 10 11:38:20 2005

With regard to the CRP issue, I disagree. If you have a lab that can provide a CRP value in a timely manner, it can give you a lead on other clinical assessments of developing infection. I can't use it where I am at because the turn-around time for the test is too long, however, I have used it in other places with good results. As with anything, I don't use it as my sole determinant, but rather as an additional piece of the puzzle to aid in decision making. 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 Peter Wein Sent: Tuesday, August 09, 2005 10:18 PM To: Multiple recipients of list OB-GYN-L Subject: Re: pprom and antibiotics

If increased latency does not improve outcome, it does not have any benefit of itself - this was shown in the amoxiclav arm of ORACLE, where there was increased latency but worse outcome if anything with antibiotic. CRP is almost valueless.

Peter

>----- Original Message ----- From: "Garry E. Siegel, M.D." <garrys@mindspring.com> To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> Sent: Wednesday, August 10, 2005 4:20 AM Subject: Re: pprom and antibiotics

> My sentiments exactly, given the immature FLM, and stated much better by > a better authority. > > Garry > > At Tue, 9 Aug 2005, Lynn D. Montgomery, M.D. wrote: >> >>In this case, the unique circumstance of a gastroschisis complicates the >>case. The pediatric anesthesiologist and pediatric surgeon will >>appreciate >>only having to deal with one problem (gastroschisis), rather than two >>(gastroschisis + respiratory). Normally, when I get a baby with PPROM to >>34 >>weeks, I deliver, regardless of information regarding lung maturity - the >>reason being the infectious risk, etc. In this case, especially with the >>information regarding immature lungs, I would use expectant management and >>periodically check the vaginal vault fluid for maturity. I would deliver >>for even the slightest indication of brewing infection (i.e. uterine >>irritability, tenderness, fever, bands on WBC or rise in CRP). Regardless >>of the strep status, I treat patients that I am expectantly managing with >>PPROM based on the studies showing an increase latency between rupture and >>onset of labor in those treated with antibiotics. >>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 Richard >>Chudacoff, MD >>Sent: Tuesday, August 09, 2005 7:35 AM >>To: Multiple recipients of list OB-GYN-L >>Subject: Re: pprom and antibiotics >> >>Okay, but her fetal lung maturity test came back immature. Now what would >>y'all do? Still afebrile, negative c-reactive protein, normal WBC, >>non-tender and acontractile. >> >>Richard Chudacoff, MD >> >>This message is confidential, intended only for the named recipient(s) and >>may contain information that is privileged or exempt from disclosure under >>applicable law. If you are not the intended recipient(s), you are notified >>that the dissemination, distribution or copying of the messages is >>strictly >>prohibited. If you receive this message in error, or are not the named >>recipient(s), please notify the sender at either the e-mail address or >>telephone number above and delete this e-mail from your computer. >>-----Original Message----- >>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain >>Ramirez >>Sent: Monday, August 08, 2005 6:46 PM >>To: Multiple recipients of list OB-GYN-L >>Subject: Re: pprom and antibiotics >> >>Give her another anitibiotic - whatever - and deliver... >> >>>At Mon, 8 Aug 2005, Garry E. Siegel, M.D. wrote: >>> >>>Agree with prompt delivery. If you had it to do all over again: >>> >>>1. Culture for GBS upon admission if no result known. >>>2. Cover with PCN for GBS. >>>3. Deliver since 35 or more. >>> >>>The gastroschisis doesn't alter management. >>> >>>My understanding is that the latency is increased with Amp/Erythromycin. >>>That is not needed here. >>> >>>Now, if you're already on Amp/Erythromycin, and she can't tolerate the >>>Erythromycin, dropall antibiotics since GBS negative and deliver. >>> >>>Garry >>> >>>At Mon, 8 Aug 2005, Charlie Chambers wrote: >>>> >>>>Not necessarily. I figure that at 36 weeks this kid has a low chance >>>>of RDS. What's the odds of chorio with PPROM or cord accident in the >>>>next week? Worst case scenario, I guess I'd rather have a kid with >>>>gastroschisis and at worst mild RDS, vs. gastroschisis wtih chorio or >>>>cord compromise. >>>> >>>>On Aug 8, 2005, at 11:23 AM, Richard Chudacoff, MD wrote: >>>> >>>>> Would fetal gastroschisis change your management with PPROM? >>>>> >>>>> Richard Chudacoff, MD >>>>> >>>>> <unknown.jpg>This message is confidential, intended only for the >>>>> named >>>>> recipient(s) and may contain information that is privileged or >>>>> exempt from disclosure under applicable law. If you are not the >>>>> intended recipient(s), you are notified that the dissemination, >>>>> distribution or copying of the messages is strictly prohibited. If >>>>> you receive this message in error, or are not the named >>>>> recipient(s), please notify the sender at either the e-mail address >>>>> or telephone number above and delete this e-mail from your computer. >>>>> >>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of >>>>> rmodugno@aol.com >>>>> Sent: Monday, August 08, 2005 1:17 PM >>>>> To: Multiple recipients of list OB-GYN-L >>>>> Subject: Re: pprom and antibiotics >>>>> >>>>> Not sure why you're not delivering this patient with pprom at 36 >>>>> weeks. >>>>> >>>>> Robert Modugno MD MBA FACOG >>>>> Marietta, GA >>>>> >>>>> -----Original Message----- >>>>> From: Richard Chudacoff, MD <rchudacoff@mylinuxisp.com> >>>>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> >>>>> Sent: Mon, 8 Aug 2005 10:29:53 -0500 >>>>> Subject: pprom and antibiotics >>>>> >>>>> I have a question, which Bob Carpenter and I have discussed, but I >>>>> wanted the groups opinion. >>>>> >>>>> 18 yo G1 at 35 weeks, PPROM. Started on Amp and Erythromycin >>>>> prophylactically, but could not tolerate the Erythro, so this was >>>>> stopped. GBS came back negative. Patient is now 36 weeks. My >>>>> question is, in the face of data that shows in increase in >>>>> resistance and necrotizing enterocolitis with ampicillin, Unasyn or >>>>> Augmentin without erythromycin, would you continue the ampicillin? >>>>> Now, let?s add the fact that the baby has gastroschisis?what would >>>>> your antibiotic option be? >>>>> >>>>> Richard Chudacoff, MD, FACOG >>>>> >>>>> Women's Specialists of Houston >>>>> 6624 Fannin Suite 1800 >>>>> >>>>> Houston, TX, 77030 >>>>> >>>>> 713-797-1144 >>>>> 713-425-3071 >>>>> >>>>> Email: Richard.Chudacoff@obgyn.net >>>>> rchudacoff.md@womenspecialists.com >>>>> >>>>> [Image removed] >>>>> This message is confidential, intended only for the named >>>>> recipient(s) and may contain information that is privileged or >>>>> exempt from disclosure under applicable law. If you are not the >>>>> intended recipient(s), you are notified that the dissemination, >>>>> distribution or copying of the messages is strictly prohibited. If >>>>> you receive this message in error, or are not the named >>>>> recipient(s), please notify the sender at either the e-mail address >>>>> or telephone number above and delete this e-mail from your computer. >>>>> >>>>********************************************************************** >>>>** >>>>**********************************************************************

>>>>**** >>>>********************************************************************** >>>>** >>>>**********************************************************************

>>>>********************************************************************** >>>>** >>>> >>>>-- >>>>Charlie Chambers >>>>Hood River, OR USA >>>>cchamber@alumni.rice.edu >>>> >>>>"...not because I regard fishing as being so terribly important but >>>>because I suspect that so many of the other concerns of men are >>>>equally unimportant-and not nearly so much fun." >>>> John Voelker >>>>********************************************************************** >>>>** >>>>**********************************************************************

>>>>***** >>>>********************************************************************** >>>>** >>>>**********************************************************************

>>>>********************************************************************** >>>>** >>>> >>>-- >>>Garry E. Siegel, M.D. >>>Private Practice >>>Roswell, GA >>> >>-- >>"Character may be manifested in the great moments, but it is made in the >>small ones." >> >> - Phillip Brooks >> >> ~walt whitman~ >> > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA

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