Re: Severe PIH 34 weeks
From: Andrew Folley (agfolley@hotmail.com)
Thu May 24 09:07:01 2007
There you go again, Steve, trying to confuse the issue with facts and
literature. agf
>From: "Raymond Stephen" <stephen.raymond@dhhs.tas.gov.au>
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: RE: Severe PIH 34 weeks
>Date: Thu, 24 May 2007 00:06:15 -0500
>
>http://www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.2007.01326.x
>
> >From the latest BJOG a trial in Amsterdam of temporisation in cases of
>pre-eclampsia, eclampsia, HELLP Syndrome and pregnancy induced
>hypertension. In all groups a median of 8 days were gained with
>appropriate treatment.
>
>And yes, it is important to distinguish between severe hypertension and
>pre-eclampsia. End-organ affectation is the whole reason why the condition
>is of clinical interest; if absent, the pregnancy can continue. Changes in
>liver, renal or placental function should be sought otherwise you are just
>practicing cook book medicine. The ten percent of eclamptics who don't
>have proteinuria before they fit will have other evidence of endothelial
>disease, and it is wrong to assume that changes in any one organ will be
>present in any other. The kidney may not be greatly affected when the
>brain is severely so and vice versa.
>
>Steve
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>rmodugno@aol.com
>Sent: Thursday, 24 May 2007 11:28 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Severe PIH 34 weeks
>
>Steve, you say deliver when something is wrong. Is a BP of 170/110
>right? She has "Gestational Hypertension?" - is that your contention?
>Why do ten percent of eclamptics not have proteinuria? Are they not
>pre-eclamptics before they seize?
>Do you have to have proteinuria and/or HeLLP to label a P0G1 with a
>BP170/110 a severe pre-eclamptic? IMHO, no.
>
>OK, let's wait for the end organ damage -seizure, abruption. Call me a
>whimp - but not on my watch! GIT R DUN!
>
>Robert Modugno MD MBA FACOG
>Sylva, NC
>
>-----Original Message-----
>From: Raymond Stephen <stephen.raymond@dhhs.tas.gov.au>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Sent: Wed, 23 May 2007 7:28 pm
>Subject: RE: Severe PIH 34 weeks
>
> What was her BP at first visit? How old is she? Without
>abnormality of bloods or urine how
>can you call this pre-eclampsia? Seems likely that she has essential
>hypertension. Give her Labetalol until the BP is
>controlled and watch for end-organ changes including placental
>function. Deliver when something is wrong, which it
>isn't yet. Steve
>------------------------------------------------------------
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R.
>------------------------------------------------------------
>Daniel Braun
>------------------------------------------------------------
> Sent: Wednesday, 23 May 2007 11:27
>PM
> To: Multiple recipients of list
>OB-GYN-L
> Subject: Re: Severe PIH 34 weeks If the BP is that high in a
>patient at 34 weeks, why do you have a 24 hour urine? Should have been
>delivered in
>less than 24 hours. IMHO Dan
>
> On 5/23/07, Andrew Folley <agfolley@hotmail.com> wrote:
> G1Po 33 weeks 6 days admitted with BP170/110. HELLP labs all
>normal 200mg
> potein in 24 hour urine. Echo 7#15 oz baby vertex AFI
>20 Doppler normal
> MCA and UA. Tracing reactive.
>
> Questions: Deliver or not deliver? How to treat
>BP? Mg yes or no and
> why? What other information needed? agf
>
> --
> R. Daniel Braun, MD FACOG(L) CMT
> Professor Emeritus
> Dept. of Obstetrics and Gynecology
> Indiana U.
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