Re: What's next
From: R. Daniel Braun (rd.braun@gmail.com)
Fri Apr 25 13:37:09 2008
I'm afraids it is mostly the latter.
The only harm ever attributed to steroids in pregnancy is related to
repeated weekly doses.
Dan
On Fri, Apr 25, 2008 at 7:49 AM, Garry E. Siegel, M.D. <
garrys@mindspring.com> wrote:
> Thanks for the input, Dan and Ef.
>
> Is there evidence to use steroids as you've suggested, or is it just
> based on experience/obstetric horse sense?
>
> Isn't there a bit of a thought that steroids may have long term growth
> consequences? In other words, there may be harm such that one shouldn't
> use them unless clearly indicated.
>
> Garry
>
> At Thu, 24 Apr 2008, Efrain Ramirez wrote:
> >
> >Agree!!!!
> >
> >Ef
> >
> >At Thu, 24 Apr 2008, R. Daniel Braun wrote:
> >>
> >>Steroids do more than prevent RDS. They also decrease incidence of IVH
> and
> >>NEC, which can still occur after 34 weeks. Risk of giving steroids is
> ??????
> >>
> >>Dan
> >>
> >>On Thu, Apr 24, 2008 at 9:05 AM, Andrew Folley <agfolley@hotmail.com>
> wrote:
> >>
> >>> I must have missed how the diagnosis of IUGR was made?agf
> >>>
> >>> > Date: Thu, 24 Apr 2008 06:11:49 -0500
> >>> > From: cdsb@bellsouth.net
> >>> > To: ob-gyn-l@mail.obgyn.net
> >>> > Subject: RE: What's next
> >>> >
> >>> > 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
> >>> >
> >>>
> >>> ------------------------------
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> >>> ------------------------------
> >>
> >>> ------------------------------
> >>> ------------------------------
> >>> ------------------------------
> >>--
> >>> ------------------------------
> >>R. Daniel Braun, MD FACOG(L) ABMP CMTh
> >>> ------------------------------
> >>Professor Emeritus
> >>> ------------------------------
> >>Dept. of Obstetrics and Gynecology
> >>Indiana U. School of Medicine
> >>
> >>R. Daniel Braun
> >>
> >>"Science without Religion is LAME; Religion without Science is BLIND"
> >>Einstein 1941
> >>
> >--
> >"I can accept failure, but I can't accept not trying." - Michael Jordan
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
R. Daniel Braun, MD FACOG(L) ABMP CMTh
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
