Re: What's next
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Apr 24 21:03:54 2008
Charles -- you are making my point - this is not a 30 weeker it's a
34-35 weekes - big difference.. I would trade NICU complications versus
intrauterine complications and possible IUFD.. thanks for your advise!!
Ef
> - At Thu, 24 Apr 2008, Charles Bloom wrote:
>
>I don't give steroids after 34 weeks either. And Garry is right, the baby
>isn't thriving, it's small.
>
>But if the fetus were say 30 weeks with IUGR, but with Reactive NST and 8/8
>BPP, then I think there wouldn't be such a rush to delivery.
>
>So the real question here I think is given an IUGR fetus with perfect
>testing, what is the EGA we would electively deliver?
>
>Everyone may have a different answer. Here is an example of there being 10
>different ways to do something in medicine and nine of them not being wrong.
>
>Charles
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
>Siegel, M.D.
>Sent: Wednesday, April 23, 2008 10:47 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: What's next
>
>Over 34 weeks--no steroids unless amnio done and lung maturity not
>proven.
>
>Yes, the late preterm baby alluded to in ACOG's Committe Bulletin has
>more morbidity, etc., but this baby is far from thriving inside.
>
>Reassuring testing is nice, but nicer is a baby in the nursery.
>
>Deliver her, my friend.
>
>Garry
>
>At Wed, 23 Apr 2008, Efrain Ramirez wrote:
>>
>>No fetal weight gain at all in the last 2 weeks.. umbilical artery
>>doppler normal.. MCA not done.. mother perceives fewer FM's.. just
>>like the other pregnancy.
>>Definitive asymmetric IUGR.
>>Level III NICU .. I had to deliver in the last year to babies at 26
>>weeks .. doing well..
>>Steroids? - it's a Democratic Primary..
>>Legally speaking an unexpected IUFD would be hard to defend... NICU
>>complications, IMHO, easier.
>>Thanks to all.. recommendations well taken.
>>
>>Ef
>>
>>At Wed, 23 Apr 2008, art fougner, md wrote:
>>>
>>>Middle cerebral artery doppler? Uterine artery doppler?
>>>If all normal, would suggest (unencumbered by data) twice weekly nst's
>>>with AFI's, weekly dopplers and elective delivery at term.
>>>
>>>Art
>>>
>>>Just my opinion. I could be wrong.
>>>
>>>At Wed, 23 Apr 2008, Efrain Ramirez wrote:
>>>>
>>>>30 some G2, P1 - previous C/S - IUGR - at 36 weeks - apparently no
>>>>reassuring FHR's.2 weeks at NICU.. at present 34 w and 5 d.. BPP
>>>>10/10, EFW - 1500-1600 below 5th.. normal umbilical Doppler .. what's
>>>>next?
>>>>
>>>>Ef
>>>>
>>>>--
>>>>"I can accept failure, but I can't accept not trying." - Michael Jordan
>>>>
>>>--
>>>art fougner, md
>>>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>>>
>>--
>>"I can accept failure, but I can't accept not trying." - Michael Jordan
>>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
"I can accept failure, but I can't accept not trying." - Michael Jordan
