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Re: Ob: Chronic HypertensionFrom: Andrew Folley (agfolley@hotmail.com)Mon Dec 24 13:41:50 2007
Garry this is the reason why you do not need to intervene. Go with the patients desires and the CNMW experience. Chronic HTN or Essential HTN without proteinuria or labs suggesting HELLP do not require intervention and DO NOT require antihypertensives (according to Sabai) unless HTN severe (ie > 160-180/110). Dont practice meddlesome obstetrics. Induce at 41 weeks. Whe will probably go into labor on her own by then. Date: Sun, 23 Dec 2007 12:31:57 -0600From: rd.braun@gmail.comTo: ob-gyn-l@dns.obgyn.netSubject: Re: Ob: Chronic HypertensionYou have about a 40-50 % chance opf ending up doing a section after all those hours of induction is the reason for a primary section.Dan On Dec 22, 2007 2:54 PM, Garry E. Siegel, M.D . <garrys@mindspring.com> wrote: Long story and have to run. . . Initially refused ripening with cervidil, and with a small baby (EFW2850 if I forgot to post it) and her cervix not too bad, I reallythought that she would fly.Patient is a P.A., partner a neurologist (from elsewhere), CNM patients whose care I assumed due to the abnormal lab study.So, she was to stay overnight for a 24 hour urine and repeat labs, andthen decided to agree to the cervidil.This AM would not let me pull the cervidil 2.5 hours before the 12 hoursto AROM and start pitocin, labs the same, BP fine.I think she needs to be delivered, and she will only allow it on herterms. We have had a couple of long conversations laced with anxiety and consternation, and I have decided to simply let her be cared for bythe CNM who is happy to do so (kindly). This will hopefully allow herto have the type of delivery she wants, hopefully sooner rather than later (to keep me happy in case we're missing something), and it keepsme from getting more gray hairs.Dan, I know that you're not there, but I don't think she needs a primarysection, even if she would agree. For those advocating continuing the pregnancy with surveillance, why? Inpractical terms, we cannot easily solve the abnormal LFT, and it seemsbest to me to get the baby out and figure this out later.Garry At Sat, 22 Dec 2007, rmodugno@aol.com wrote:>>Would offer induction - have had good results with the Atad cervical >ripening balloon.>>Robert Modugno MD MBA FACOG>Sylva, NC>>-----Original Message----->From: R. Daniel Braun <rd.braun@gmail.com> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>>Sent: Sat, 22 Dec 2007 10:20 am>Subject: Re: Ob: Chronic Hypertension>>Obvious Premium Preg. (I know they all are, but she is less likely to >have another chance)>>ERGO:>>Bird in Hand rule.>>Deliver by C/S now. (Head at -2 station in a 35 Y/O nullipara. Forget>induction)>>If she says no because she wants the touchy feely of a vaginal >delivery, have her sign an informed refusal showing that you tried.>>Dan>>On Dec 21, 2007 11:03 PM, Garry E. Siegel,>M.D. garrys@mindspring.com > wrote:>35 YO P0 at 39w3d, seen by our CNMs primarily>>Donor sperm, IUI by choice (female partner)>>No diagnosis ever made of chronic hypertension, but she says that she>runs 140/90, and in prenatal visits since 26 weeks in our practice has >BP's 135 to 150/85 to 90.>>Two weeks ago, placed on Aldoment 250 BID by one partner.>>Today saw once CNM for a routine visit, asymptomatic, but 138/90 and>sent to L and D for NST and blood work (not sure why, but I wasn't >involved in the decision).>>BP 140/90 or so in L and D, NST reactive, EFW 2850g, cervix>1.5/50/soft/-2/posterior.>>Creatinine 0.6, Platelets 170K, Hematocrit 36, SGOT 34 (upper normal >33).>>What is your diagnosis?>>What is your plan of action?>>Garry>>-->Garry E. Siegel, M.D.>Private Practice>Roswell, GA>>-- >R. Daniel Braun, MD FACOG(L) CMT>Professor Emeritus>>Dept. of Obstetrics and Gynecology>Indiana U. School of Medicine>>R. Danie ut Religion is LAME; Religion without Science is BLIND" Einstein 1941 07
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