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Re: 20 weeks with PPROM + previaFrom: DoctorJoe@aol.comTue Jul 2 08:02:43 1996
<<I see your point, but disagree. There are a number of possibilities. There could be a "high leak" above the previa, or more likely there could be a leak at the os with leakage around the placenta. Water, or amniotic fluid, has amazing abilities to sneak around barriers. For brevity, I did not mention that she had an amniocentesis with instillation of indigo carmine that leaked into the vagina (amnio negative for infection). She is not my patient, but I'm sure the physician managing her can diagnose leaking indigo carmine!>> Well, I'm still wondering about how much fluid is left and what about expectant management? In fact, the Japanese have done cerclage with antibiotic instillation (which in this case could be done simply by IV antibiotics... something like the penicillins which get across the placenta well and are excreted in fetal urine). That may be too dashing and daring for you, but it depends on the patient, the docs, and the situation. ************************************************* 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 ("The Big Easy") U.S.A. *************************************************
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