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Re: OB: Previous PIH/Lumbar Disc Disease (long)--results From: Garry E. Siegel, M.D. (garrys@mindspring.com) Wed Dec 30 19:28:28 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "OB: Twin delivery/availablity of anesthesiologist--long" Previous message: Dean Huffman: "A Word About ABOG Recertification Deadlines..." In reply to: Garry E. Siegel, M.D.: "OB: Previous PIH/Lumbar Disc Disease (long)" At Mon, 21 Dec 1998, Garry E. Siegel, M.D. wrote: > >I would love some opinions on the following new patient, and would >especially like some MFM comments (LSR?--I hear that you are the meta >analysis king!). > >37 YO P2012 at 8 weeks by LMP, 7 weeks 2 days by scan today; the history >is from the patient, who is an RN, and no records are available yet. She >has no diagnosis of chronic hypertension. > >1988--PIH near term, about 38 weeks, induced for a vaginal delivery, 5 >pound, 15 ounces. > >1991--30 weeks, bedrest for BP elevation; 33 weeks, headaches, >hospitalized for one week, even on Magnesium; eventually home, and had >weekly amnios for maturity, and delivered by C/S at 38 weeks due to >breech, low fluid (but one pocket for the tap, she said). > >1993--8 week missed AB., D and C. > >All with the same husband. > >She now presents for routine care, and also states that she has lumbar >spinal stenosis, and herniated discs, and she has been operated on once >for a lumbar microdiscectomy. Her exam is normal, BP 130/88, and she is >obese at 200 pounds or so, 5 feet 6 inches or so (I'm guessing). > >So. . . > >1. What workup would you do for this BP history? My MFM consultant >recommends a baseline metabolic panel, creat clearance, thyroid test, >ANA, and antiphospholipid antibodies. > >2. Would you treat her with baby ASA, calcium, both, or neither? > >3. What would you quote her risk of recurrent PIH as, other than >"pretty high?" > >4. If she had a previous transverse C/Section, would you recommend a >VBAC given her back disease. She has had lumbar steroid injections for >therapy. > >Garry > >-- >Garry E. Siegel, M.D., FACOG >Private Practice >Roswell, Ga. > Lab results: LFTs normal, thyroids normal, Creat clearance 120 cc/min, serum creatinine 0.9, Lupus anticoagulant and anticardiolipin antibody negative, ANA positive at 1:40, which is low positive. What would you do now? I'll post my MFM recommendations in a bit. Garry -- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga. Next message: Garry E. Siegel, M.D.: "OB: Twin delivery/availablity of anesthesiologist--long" Previous message: Dean Huffman: "A Word About ABOG Recertification Deadlines..." In reply to: Garry E. Siegel, M.D.: "OB: Previous PIH/Lumbar Disc Disease (long)"

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