Re: What would you do, new case
From: jay kulkin (jkulkin@mindspring.com)
Sat Jan 4 21:07:48 1997
I believe we have to consider this primigravida as having PIH and be
extremely cognizant that she has an extremely good chance of developing mild
pre-eclampsia. While I agree with most of the management, I would want to
document with a 24 hour urine that I have <300 mg protein/24 hrs.. I think
this is unfortunately necessary medical-legally. At 37 weeks, you have
everything to lose and nothing to gain if she in fact is pre-eclamptic. If
she is I would deliver at 38 weeks and not wait until 40 even if I had to
ripen her cervix.
Jay
At 08:19 AM 1/4/97 -0600, you wrote:
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>Garry E. Siegel wrote:
>
>> 30 YO nulligravida with an uncomplicated pregnancy presents for
>routine
>> visit at 37 weeks. Her blood pressure (taken by the nurse, sitting)
>is
>> 120/80, no proteinuria, and a 5 pound weight gain in 2 weeks. Her
>baseline
>> BPs since 8 weeks, and in prior gyn visits, are 100 to 110/60 to 70
>> Upon return at 38 weeks, she remains symptom free, gained 1 pound, has
>1 +
>> voided protein (no other positives on dipstick), and has a BP of
>138/94,
>> repeated 140/85.
>
>I think the first thing is to entertain a possible diagnosis. You might
>have done a quick mini-cath to rule out urine specimen contamination. I
>would probably get an NST in the office, send her to the lab for CBC,
>platelet count, give her warnings about pre-eclampsia symptoms, and send
>her home to bed rest L side if the tracing is reactive.
>
>Call her back if her platelet count is under 100Kand put her in the
>hospital. Otherwise follow up in 48-72 hours.
>
>> Diagnosis, if any?
>
>I don't think you can call it anything but some type of pregnancy
>induced hypertension until you have more reason to suspect toxemia (I
>like this term-it's shorter to write).
>>
>> Treatment options, if needed?
>
>bed rest.
>
>NB. I had a woman like this just recently...She was moderately obese to
>begin with. A little positional hypertension that always corrected.
>Never more than 1+ proteinuria. Trace edema. Platelets always >150K.
>She spontaneouly ruptured her membranes. She got an epidural in labor,
>her pressures normalized, everything else went smoothly.
>
>Douglas Krell MD
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><DT>Garry E. Siegel wrote:<BR>
><BR>
>> 30 YO nulligravida with an uncomplicated pregnancy presents for
routine<BR>
>> visit at 37 weeks. Her blood pressure (taken by the nurse, sitting)
>is<BR>
>> 120/80, no proteinuria, and a 5 pound weight gain in 2 weeks.
>Her baseline<BR>
>> BPs since 8 weeks, and in prior gyn visits, are 100 to 110/60 to 70<BR>
>> Upon return at 38 weeks, she remains symptom free, gained 1 pound,
>has 1 +<BR>
>> voided protein (no other positives on dipstick), and has a BP of
138/94,<BR>
>> repeated 140/85.<BR>
><BR>
>I think the first thing is to entertain a possible diagnosis. You
>might have done a quick mini-cath to rule out urine specimen
contamination.
>I would probably get an NST in the office, send her to the lab for CBC,
>platelet count, give her warnings about pre-eclampsia symptoms, and send
>her home to bed rest L side if the tracing is reactive.</DT>
>
><DT> </DT>
>
><DT>Call her back if her platelet count is under 100Kand put her in the
>hospital. Otherwise follow up in 48-72 hours.</DT>
>
><DT><BR>
>> Diagnosis, if any?</DT>
>
><DT> </DT>
>
><DT>I don't think you can call it anything but some type of pregnancy induced
>hypertension until you have more reason to suspect toxemia (I like this
>term-it's shorter to write).<BR>
>> <BR>
>> Treatment options, if needed?</DT>
>
><DT> </DT>
>
><DT>bed rest. </DT>
>
><DT> </DT>
>
><DT> </DT>
>
><DT>NB. I had a woman like this just recently...She was moderately
>obese to begin with. A little positional hypertension that always
>corrected. Never more than 1+ proteinuria. Trace edema.
>Platelets always >150K. She spontaneouly ruptured her membranes.
>She got an epidural in labor, her pressures normalized, everything else
>went smoothly.</DT>
>
><DT> </DT>
>
><DT>Douglas Krell MD<BR>
><BR></DT>
>
><DT><BR>
> </DT>
>
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