PREGNANCY-BIRTH Messages for May, 2000: Re: post: Clostridium difficile and pregnancy

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Re: post: Clostridium difficile and pregnancy - MD with knowledge please respond.

From: William F. von Almen, II, MD, FACOG (anonymous@obgyn.net)
Sun, 28 May 2000 15:41:40 -0500 (CDT)

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In reply to: LD: "Repost: Clostridium difficile and pregnancy - MD with knowledge please respond."

At Sun, 28 May 2000, LD wrote: >
>Hi I previously posted this, but unfortunately the response was not
>useful...
>
>I am a cerclage patient with a history of loss at 25 weeks due to
>chorioamnionitis. Because of this history and signs of PTL.. I was put
>on IV clindamycin at 24 weeks during this pregnancy. I am now 34 weeks.
>I have been experiencing moderate diarrhea (3-4 times per day) for about
>11 days now. Today, it has let up and seems to be clearing. Along with
>the diarrhea I had terrible nausea that also seems better. However, I
>did submit a stool sample a few days ago - which came back positive for
>c.dif today. I started taking Metronidazole, 250 m.g. p.o. t.i.d.
>today. I have taken two doses. My last bowel movement was solid but a
>dark black-green color. My question is 1.) Is this treatment adequate
>or should I be taking 500 m.g. qid? 2.) Can the endotoxin A that is
>produced by this infection cross the placenta and harm my baby? 3.) Have
>you treated this before in pregnancy and what is your general experience
>regarding resolution of the infection? I am concerned that if I am being
>undertreated I am increasing my chances of going septic from this... the
>only medical history I have is incompetent cervix, otherwise I am
>healthy to the best of my knowledge. Oh and lastly, are the effects of
>metronidazole on the fetus relatively benign or is this an issue as
>well?
>Thanks, LD

LD Thisis a very pesky disease. Sorry you have been burdened with it. Ithink the dose of flagyl is sufficient, but each patient is different. It should not be harmful to the baby. I am not aware of the ability of the endotoxin to cross the placenta, but I felt the toxin was a locally acting problem and not systemic. Better ask your GI consultant about this. I have only treated this postpartally, sorry. Good Luck, stay on top of it, remember, there are other drugs that can be used if you do not respond to the flagyl.

--
William F. von Almen, II, MD, FACOG
Editorial Advisor-Pregnancy and Birth
Private Practice
New Orleans, La.

*Please understand I can not respond to private emails.

*These comments are for educational purposes only.  They are
not meant to take the place of an examination by a qualified
health care provider.  They are not intended to be the start
of a physician-patient relationship.

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