Re: OB: Severe Pre-eclampsia
From: Andrew Folley (agfolley@hotmail.com)
Fri Oct 7 13:09:52 2005
What happned to the baby?
>From: garrys@mindspring.com (Garry E. Siegel, M.D.)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Re: OB: Severe Pre-eclampsia
>Date: Thu, 6 Oct 2005 15:47:05 -0500
>
>Indeed, I didn't need a stinking MFM, but posed the question regarding
>delivering for proteinuria as the sole reason to diagnose severe disease
>under 32 weeks.
>
>For this case, she was ripened with cervidil once the diagnosis of
>severe disease was made, and induced and delivered the next day at 4 PM.
>
>My thought was to deliver her once she became severe since over 34, and,
>honestly, if over 32 with severe disease, you only can buy a few days
>before somthing will make you move.
>
>As an old guy, I see no reason to sit on a patient with severe disease
>(even if only proteinuria)over 34 to 35, if not 32! As someone said,
>nothing good is going to happen.
>
>I was surprised that anyone would sit on her and wait even until 36
>weeks.
>
>I was suprised Dan wanted to section, not induce.
>
>Magnesium? My partner who set up the ripening said, "only if her BP acts
>up." Me? If you have severe disease, you need Magnesium, and that is
>what ACOG says.
>
>So, alls well that ends well. . .
>
>3 hours PP she continued to have atonic episodes, and went to the OR for
>an EUA/D and C--clots, maybe tissue obtained, Hct dropped to 15%--she
>responded to IV pitocin, several doses of Hemabate, and received 5 units
>of PRBCs.
>
>All is well 24 hours PP now as I post.
>
>I'm so glad I ripened/induced and delivered :).
>
>Garry
>
>At Thu, 6 Oct 2005, Lynn D. Montgomery, M.D. wrote:
> >
> >(You don't need no steenkin' MFM! Sorry Dr Montgomery!)
> >
> >Hey, no problem. I did just as much clinical high risk during the five
> >years prior to going back for my fellowship as I do now. My fellowship
>time
> >was primarily spent having Bob Carpenter refine my ultrasound skills and
> >teach me fetal therapy.
> >Lynn
> >
> >Robert Modugno MD MBA FACOG
> >Marietta, GA
> >
> >-----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: Wed, 5 Oct 2005 17:15:37 -0500
> >Subject: OB: Severe Pre-eclampsia
> >
> >36 YO P1001 admitted at 34w2d with 150/90, 2+ protein, no symptoms,
> >
> >normal SGOT, platelets, and creatinine of 0.7.
> >
> >24 hour protein 2.6 grams while in house.
> >
> >Next 24 hour urine begun.
> >
> >Our MFMs generally say don't deliver for severe disease if only for
> >
> >proteinuria, but generally that seems to be for the under 32-weekers.
> >
> >Usually, by the time they are severe by proteinuria, something else
> >
> >declares itself such that delivery is necessary.
> >
> >The next urine came back at 34w6d at 6.2 grams; other labs normal. Her
> >
> >cervix is long/closed, and she's delivered vaginally before at term
> >
> >without PIH. The MFM scan is normal with normal dopplers, 8/8 BPP and
> >
> >OK growth.
> >
> >What would you do?
> >
> >If you choose to induce, would you use Magnesium Sulfate?
> >
> >Garry
> >
> >--
> >
> >Garry E. Siegel, M.D.
> >
> >Private Practice
> >
> >Roswell, GA
> >
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
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