Re: Deliver now or Special Delivery later
From: Dr Eberhard Wl Lisse (el@lisse.na)
Mon Jun 29 00:39:21 2009
As my Cuban friend, the semi-literate quack, would say`;
"Complicate!, We must out the baby! Now, now, Now"
el
On 29 Jun 2009, at 02:00 , JD Stewart,MD wrote:
> Pardon the tone,......but this has set me off.
>
> At Sat, 27 Jun 2009, Andrew Folley wrote:
>>
>> Definitely wait and watch careflully in house would like to get to
>> 28 weeks for improved neonatal outcome. Degree of proteinuria???
>>
>
> Wait and Watch carefully for what? A transfer to the Path in the
> basement on the fuzzy blanket gurney?
>
> What other disease process did you have in mind that will be fine with
> vital signs , office exam (no/low proteinuria), labs and baby exam 2
> weeks earlier, and then present with increasing headache,swelling,
> BP's
> in this range and seizures? Lupus plus dodgeball?
>
> She is eclamptic and already on MagSo4, and her critical level of
> hypertension is "responding" only to 2 IV meds....What's the plan?
> What
> is your "definite" next therapy for the next 3 weeks when this is no
> longer enough? Cochrane deep water immersion or abdominal
> decompression?
>
> When did a month of bedrest, nitroprusside, diuretics, phenytoin and
> "careful watching" ever begin to work for eclampsia?
>
> The question of gaining 24-48 hours for steroids is a reasonable
> question...not a lot of definite evidence this helps in light of the
> increased risks of abruption/ seizure/ mortality in this setting...the
> steroid studies were derived from large populations of "normal" early
> deliveries, and the findings transported to all clinical situations,
> just because...well, we think ( and opine...)it should work.
>
> Caveat- Even on Dr Sibai's service with all the papers he has
> published
> on this, he managed to squeak out these few weeks for quite a few
> patients, and proved it could be done in his particular setting with
> an
> army of students, residents and fellows, but really failed to show a
> lot
> of benefit to neonatal outcomes for the effort, or any further
> improvement over the outcomes of the delivered 25-28 weekers in the
> NICU....so if you are doing this "for the baby", think twice before
> blindly applying the "28 weeks in utero just has to be better"
> principle
> for this baby...
>
> The added phrase "definitely" would merit repeating the OB rotation in
> med school..or a guest appearance at law school...
>
> At Sat, 27 Jun 2009, Andrew Folley wrote:
>>
>> Definitely wait and watch careflully in house would like to get to
>> 28 weeks for improved neonatal outcome. Degree of proteinuria???
>>
>> Date: Sat, 27 Jun 2009 15:48:57 -0500
>> From: 4obgyn@gmail.com
>> To: ob-gyn-l@mail.obgyn.net
>> Subject: Deliver now or later
>>
>> 33 yo G1 P0 presented @ 25 4/7 weeks EGA after a witness seizure at
>> work. Brought in by ambulance and seized again in ER. BP
>> 220/160. No significant past medical history. Husband did say she
>> had headaches for one week and swelling for two weeks. Also was
>> hit by a dodge ball on her forehead three days before
>> presentation. She was last seen by her ob two weeks ago when it
>> was uneventful. She had a negative CT of the head prior to being
>> released from the ER to L&D. Baby's heart beat now in normal
>> range. Cervix closed, firm, uneffaced. Cephalic presentation by
>> ultrasound. MgSO4 given in ER, BP gradually responding to
>> Hydralazine and Labetolol. No coagulation abnormalities. I am
>> wondering how many of you folks will deliver her right away, or how
>> many will give her steroids and wait? Thanks in advance for you
>> input.
>>
>> Allan
>
> --
> JD Stewart, MD
> MFM up all night, every night
> 10 years later..
>
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