OB-GYN-L Messages for December, 2007: Re: Ob: Chronic Hypertension

Re: Ob: Chronic Hypertension

From: Andrew Folley

agfolley@hotmail.com

Mon Dec 24 13:43:08 2007

Date: Sun, 23 Dec 2007 15:58:06 -0600From: rd.braun@gmail.comTo: ob-gyn-l@dns.obgyn.netSubject: Re: Ob: Chronic HypertensionAnd the 50 % increase in postop infection rate and an even higher rate of PE just because she was in labor for 36 hours before having the section. Does she know about that risk also??Dan On Dec 23, 2007 4:14 PM, westsidebirthservice@juno.com <westsidebirthservice@juno.com> wrote:

Dan, She still needs to feel she did all she could to have this baby vaginally. If she has a section without that chance she'll always wonder if she could have done it after all and will always blame the doctor for "doing" the birth for her. Yes, she may well end up having a section, but she deserves her feelings and her chance. Certainly we have all known of cases where we were sure the woman would have a section, and we've been right, but the woman still needs to do whatever it is she has dreamed about and planned for. At some point in this labor it will be clear to everyone that the time is right for the section and the woman will know it as well. Time, time, time. Louana

-- "R. Daniel Braun" <rd.braun@gmail.com> wrote:You 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 (EFW 2850 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 by the 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 keeps me 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? In practical 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. Dani out Religion is LAME; Religion without Science is BLIND" Einstein 1941 -- R. Daniel Braun, MD FACOG(L) CMTProfessor EmeritusDept. of Obstetrics and GynecologyIndiana U. School of MedicineR. Daniel Braun "Science without Religion is LAME; Religion without Science is BLIND" Einstein 1941 _________________________________________________________________ Don't get caught with egg on your face. Play Chicktionary! _________________________________________________________________ http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec

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