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Re: I have less problems these days, thanks to the listFrom: DoctorJoe@aol.comFri Dec 15 07:06:12 1995
I think we are getting a little off of the subject here, but okay, in answer to Dr. Staka's comments, etc.: <<Is that OK to consider termiantion of pregnency before 28th week as delivery?>> Termination of pregnancy is termination of pregnancy. If you deliver the baby for chorioamnionitis at 37 weeks, it's a delivery. If you have to deliver the baby at 22 weeks because of chorioamnionitis, it's a delivery. Obviously, the chances for the baby are quite different. <<We have to take in consideration in such cases estimated chance of baby, and balance risk-benefit /from fetal point of view/ before 30th week is really poor.>> We ALWAYS should consider the risk-benefit ratio, etc. But that wasn't the point of the original comment. Someone said something about clergy being involved in a decision to deliver someone with chorioamnionitis and a previable pregnancy. <<So-antibiotics and ? /magnesium, beta-mimetics/ to keep fetus intrauterinely in better condition rather than delivery of extreme premature baby.>> In the USA, tocolytics in the face of ruptured membranes and chorioamnionitis would be considered below the standard of care (comments, anyone?). The scenario we were discussing, I thought, was pretty clear cut. HOWEVER, there is some literature support for use of antibiotics WITHOUT delivery in women with primary chorioamnionitis with INTACT membranes (cases of listeriosis come to mind), although these reports are anecdotal. (It would be nice to collect them and summarize them.) <<How about fetal rights? Has the fetus right to threat mother? >> I don't think we were talking about fetal rights or fetal threats. The question was involvement by clergy, and I was asking about that. [Of course, don't ALL fetuses threaten their mothers? They suck off glucose, Fe++, protein, Ca++; they cause glucose intolerance; they interfere with the immune system; they give stretch marks; etc.] <<You have to inform Your patients about all possibilities>> Nobody is arguing about that. The question was one of interaction with the clergy about a fairly straight forward medical case. <<I'd say that there is no coherent concept of primary intent AND standard practice.>> Of course there are concepts of both. In my example of a pregnancy and cervical cancer: If you radiate a woman with cervical cancer, you're intent is TO TREAT THE CANCER. If she happens to be pregnant and you kill the baby, THAT WAS _NOT_ YOUR INTENT. The radiation therapy is a STANDARD THERAPY. Radiation therapy is NOT intended to cause abortion, although that is a side effect. This is an interesting topic, and it's one that should get more 'air time'. ************************************************* doctorjoe@aol.com "All things are connected. Joseph Pastorek, MD Some things are just more Department of OB-GYN connected than others." LSU Medical Center - Dirk Gently New Orleans, LA U.S.A. *************************************************
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