Re: 28 weeks centralization of flow
From: art fougner, md (evsono@pipeline.com)
Fri May 25 07:37:17 2007
Andrew
Abnormal arterial dopplers connote hypoxemia.
Abnormal venous dopplers connote acidemia.
Delivery seems prudent.
Art
At Thu, 24 May 2007, Andrew Folley wrote:
>
>Here is an easier one. G1P0 36 year old. 28 weeks with chronic htn has US
>done showing 24 week infant 700 grams asymmetric IUGR less 10 percentile
>with centralization of flow and flow through ductus venosus diminished. Mom
>is 300 pounds. This is a no brainer IMHO. Give steroids and section 12
>hours after 2nd dose.
>
>>From: "Richard Kaplan" <rkaplan@triad.rr.com>
>>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 12:11:48 -0500
>>
>>Andrew,
>>I agree with you on not rushing to deliver this patient. There are no
>>signs of placental insufficiency and you are monitoring the patient's blood
>>pressure and the fetal condition carefully. We are too willing to make our
>>problem the neonatologist's problem. Some 34 wk. preterm babies have
>>significant complications in the nursery.
>>
>>Richard Kaplan
>>Greensboro
>>
>>>>----- Original Message ----- From: "Andrew Folley" <agfolley@hotmail.com>
>>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
>>Sent: Wednesday, May 23, 2007 1:23 PM
>>Subject: Re: Severe PIH 34 weeks
>>
>>>Other than for Barb I seem to be the only dissenting opinion here
>>>regarding management. First of all she does not have preeclampsia neither
>>>mild nor severe. She has no significant proteinuria. She does have
>>>severe hypertension. This may PIH or underlying hypertensiion exacerbated
>>>by pregnancy. As I said the pts. labs are all normal. The babies studies
>>>are all normal other than the fact that the babies amnio shows immaturity
>>>and the baby is LGA at 34 weeks. It is easy to say deliver her by section
>>>or whatever but where is the thought process??? Why is this baby better
>>>off in the NICU than in the mother hospitalized and under observation?
>>>
>>>>From: evsono@pipeline.com (art fougner, md)
>>>>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: Wed, 23 May 2007 11:33:22 -0500
>>>>
>>>>IMHO, the hang-up with worrying about the classification of this woman's
>>>>admittedly severe HBP has clouded the minds of those managing her care.
>>>>Stabilize and deliver is the only logical management. If the nursery
>>>>can't handle an 8 pound baby, close the nursery.
>>>>
>>>>Just my opinion - I could be wrong.
>>>>
>>>>Art
>>>>At Wed, 23 May 2007, Dr Eberhard Lisse wrote:
>>>> >
>>>> >What are you waiting for?
>>>> >
>>>> >el
>>>> >
>>>> >on 5/23/07 4:57 PM Harrison Sheld said the following:
>>>> >> Is she a user?
>>>> >>
>>>> >> Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote:
>>>> >>> At Wed, 23 May 2007, Andrew Folley 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
>>>> >>>>
>>>> >>> Whats the cervix like, agree with labetolol , if she had a normal
>>>> >>> B.p.
>>>> 2
>>>> >>> weeks ago and two B.P. levels of 170/110 then she has sevevre
>>>> >>> pre-eclampsia. Deliver now, c-section or induction depending on
>>>>cervix.
>>>> >>> Bethamethasone at 34 wks in severe pre-eclampsia , why bother, you
>>>>have
>>>> >>> the perfect indication for delievery now; B.p. can take off despite
>>>> >>> labetolol and MgSo4, she is set up for aburption and siezure; if she
>>>>is
>>>> >>> sick enough for MgSo4 then she is sick enough to be delievered now.
>>>>If
>>>> >>> anything goes wrong she will also be labelled as gestional diabetic
>>>>,
>>>>is
>>>> >>> she obesese?. If she was 27 wks risk analysis may justify
>>>> >>> procrastination; a 33 6/7 wk 8 lbs baby with a little rds beats a
>>>> >>> dead
>>>> >>> 341/7 wks baby any day of the week. Deliever now with a platlet >>>
>>>>count
>>>> >>> over 150k under spnial/epidural, you may have to do c-section with
>>>> >>> platlet count of 20K in 2days.
>>>> >>>
>>>> >>> --
>>>> >>> Take care, John
>>>> >>>
>>>> >--
>>>> >Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
>>>> >el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
>>>> >PO Box 8421 \ / Please do NOT email to this address
>>>> >Bachbrecht, Namibia ;____/ if it is DNS related in ANY way
>>>> >
>>>>
>>>>--
>>>>art fougner, md
>>>>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>>
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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
