Re: Post Partum Hypertension
From: art fougner, md (evsono@pipeline.com)
Mon Jun 11 19:05:54 2007
If this trend continues, it'll be a miracle if anyone ever leaves the
hospital.
Sheer madness ...
Art
At Mon, 11 Jun 2007, D. Ashley Hill wrote:
>
>If indicated, procardia has a diuretic effect, also. I reviewed a
>medmal case several years ago for the defense, where a generalist and
>MFM sent home an asymptomatic patient with a BP of 150/95. She later
>had an embolism, which the PI attorney attributed to "negligent
>discharge while hypertensive." You might think it would have been easy
>for the defendant to get out of this case, but it was not. All it takes
>is the "shadow of a doubt" by the jury. Thanks,
>
>Ashley
>
>At Mon, 11 Jun 2007, Deborah.Bopp@memorialhealthsystem.com wrote:
>>
>>Our perinatologists send them home with oral lasix for a couple of days as well
>>
>>Deborah Bopp
>>RN, MS
>>Perinatal Clinical Nurse Specialist
>>The Birth Center
>>Memorial Hospital
>>Colorado Springs, Colorado
>>80919
>>719-365-5080
>>deborah.bopp@memoriahealthsystem.com
>>
>> eramirezt@coqui.net (Efrain Ramirez)
>>
>> Sent by: ob-gyn-l@obgyn.net To
>> Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>> cc
>> 06/09/2007 12:41 PM
>> Subject
>> Re: Post Partum Hypertension
>> Please respond to
>> ob-gyn-l@obgyn.net
>>
>>BP home monitoring - phone calls - adjust dose- I've seen patients (I
>>know you too) with BP's at ER one week later with 170/110..
>>
>>Ef
>>
>>>At Sat, 9 Jun 2007, Charlie Chambers wrote:
>>>
>>>I only treat if I'm concerned about any acute complications of
>>>hypertensive. Otherwise, a large percentage will normalize without
>>>meds, and I'm more concerned about them being hypotensive at home
>>>with a newborn.
>>>
>>>On Jun 9, 2007, at 9:49 AM, Andrew Folley wrote:
>>>
>>>> Is anyone treating women who had pregnancies complicated by mild
>>>> preeclampsia or with mild PIH who are now day 1 or 2 post partum
>>>> and continue to have high BP ie 140-150/90-110???
>>>> I see no reason to treat but several colleagues want to send them
>>>> home on Labetalol etc for 6 weeks? agf
>>>>
>>>>> From: Charlie Chambers <ricechaz@earthlink.net>
>>>>> Reply-To: ob-gyn-l@obgyn.net
>>>>> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>>>> Subject: Re: prom
>>>>> Date: Fri, 8 Jun 2007 16:32:45 -0500
>>>>>
>>>>> What about if induction is started and delivery appears greater
>>>>> than 24 hours away, would you give antibiotics prophylactically?
>>>>>
>>>>> On Jun 8, 2007, at 2:19 PM, Garry E. Siegel, M.D. wrote:
>>>>>
>>>>>> Ashley makes a very good point--but I think a quick admission
>>>>>> scan for
>>>>>> presentation is paramount. For those of us who don't routinely
>>>>>> do their
>>>>>> own scans (I am very slow but can do it), a quick look at fluid and
>>>>>> presentation is a good idea.
>>>>>>
>>>>>> Term PROM? Induce. . .
>>>>>>
>>>>>> Garry
>>>>>>
>>>>>> At Fri, 8 Jun 2007, D. Ashley Hill wrote:
>>>>>>>
>>>>>>> I would add one more thing: keep fingers out of the vagina! We
>>>>>>> take a
>>>>>>> lot of transfers from outlying hospitals via ambulance or
>>>>>>> helicopter of
>>>>>>> PPROM patients, and it's a real challenge to keep physicians,
>>>>>>> midwives
>>>>>>> and nurses from performing 1 (or more) digital exams. Not too
>>>>>>> long ago
>>>>>>> a patient got 3 digital exams prior to transfer! Either they
>>>>>>> don't know
>>>
>>>>>>> they are
>>>>>>> afraid of putting someone in a helicopter without knowing if
>>>>>>> they are
>>>>>>> dilated. We advise a speculum exam prior to transfer, which
>>>>>>> should do
>>>>>>> the trick. Have a good w/e.
>>>>>>>
>>>>>>> Ashley
>>>>>>>
>>>>>>> At Fri, 8 Jun 2007, Lynn Montgomery wrote:
>>>>>>>>
>>>>>>>> Question to the group to achieve some sort of consensus: in
>>>>>>>> premature
>>>>>>>> rupture of membranes, what are the opinions of starting
>>>>>>>> antibiotics?
>>>>>>>> Wait for fever, start if delivery is not anticipated or
>>>>>>>> achieved, any
>>>
>>>>>>>> and
>>>>>>>> after discussion, all of us are all over the map.
>>>>>>>>
>>>>>>>> Charlie,
>>>>>>>>
>>>>>>>> Typically, what I do is start ampicillin 2 grams q4h and
>>>>>>>> continue this
>>>>>>>> for 48 hours, regardless of culture results (60-70% will
>>>>>>>> deliver within
>>>>>>>> 48 hours regardless). If a patient makes it 48 hours, then I
>>>>>>>> switch
>>>>>>>> them to the "Mercer protocol", which includes oral
>>>>>>>> amoxicillin/erythromycin - I know, it is a strange
>>>>>>>> combination, but the
>>>
>>>>>>>> Studies
>>>>>>>> have shown that this extends the latent period prior to delivery
>>>>>>>> compared with controls (range from 5-7 days longer) without
>>>>>>>> increasing
>>>
>>>>>>>> the
>>>>>>>> those remaining undelivered at 48 hours, they will deliver at
>>>>>>>> a rate of
>>>>>>>> 50% each week thereafter.
>>>>>>>>
>>>>>>>> If, at anytime during their hospitalization, they go into
>>>>>>>> labor, I will
>>>>>>>> check a WBC, as well as assess for fever. If, based on this,
>>>>>>>> they seem
>>>>>>>> clinically infected (cause there is very likely an intrauterine
>>>>>>>> infection whether manifest as just labor or other signs) I
>>>>>>>> will begin
>>>>>>>> broader spectrum antibiotics during labor. If they do not
>>>>>>>> manifest
>>>>>>>> findings of a clinical infection (beyond labor), I don't start
>>>>>>>> antibiotics because delivery will take care of any sub-clinical
>>>>>>>> infection in most cases.
>>>>>>>>
>>>>>>>> Lynn
>>>>>>>
>>>>>>> --
>>>>>>> D. Ashley Hill, MD
>>>>>>> Associate Director
>>>>>>> Department of Obstetrics and Gynecology
>>>>>>> Florida Hospital Family Practice Residency
>>>>>>> Medical Director, Loch Haven Ob/Gyn Group
>>>>>>> Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>>>>>>> Orlando, Florida
>>>>>>>
>>>>>> --
>>>>>> Garry E. Siegel, M.D.
>>>>>> Private Practice
>>>>>> Roswell, GA
>>>>>
>>>>> *** ****
>>>>> Charlie Chambers
>>>>> Hood River, OR
>>>>> cchamber@alumni.rice.edu
>>>>>
>>>>> "Almost anything you do will seem insignificant but it is very
>>>>> important
>>>>> that you do it....You must be the change you wish to see in the
>>>>> world"
>>>>> -- Mahatma Ghandi.
>>>
>>>>> *** *******
>>>>>
>>>> _________________________________________________________________
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>>>
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>>>>
>>>****
>>>
>>>--
>>>Charlie Chambers
>>>Hood River, OR
>>>cchamber@alumni.rice.edu
>>>
>>>"Almost anything you do will seem insignificant but it is very important
>>>that you do it....You must be the change you wish to see in the world"
>>> -- Mahatma Ghandi.
>>>
>>>*******
>>>
>>--
>>“ The greatest obstacle to knowledge is not ignorance,
>>it is the illusion of knowledge.” Daniel J. Boorstin - Historian
>>
>--
>D. Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Medical Director, Loch Haven Ob/Gyn Group
>Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>Orlando, Florida
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
