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Re: GBS, cerclage, steroids: conflicting info
From: Jas (anonymous@obgyn.net)
Thu, 11 Nov 1999 11:39:48 -0600 (CST)
Hi Patti
I can only share my opinion on a couple of your questions. As a
cerclage person myself (I have had 5 in the past) 28 weeks is considered
late. I don't know if I buy the benefit of doing one at that stage of
the game that it is better or not because triplets is a whole different
ballgame.
About the steroid shots I had them weekly from 24-34 weeks and I had a
wonderful outcome (DD born at end of 34 weeks and no intervention
needed). I would do them again in a heart beat and if I was expecting
multiples I definately would insist. Drs will say there is no eveidence
that the shots improve outcome if given preventatively rather than 24-48
hrs before delivery. My peri had told me they don't hurt either so why
wouldn't you do them. I guess its all how you want to play the odds
game. If you think you can predict if you got a window of time before
delivery than I say risk and wait but if you want the play it safe route
I would get them. I was told one of the possible effect might be the
baby would be glucose intolerant from the shots but my daughter was
fine.
Good luck and best wishes
At Wed, 10 Nov 1999, Patti Tessler, FNP wrote:
>
>Hello, it's me, from the other side of the fence...
>
>I'm at 28w1d with triplets, on Brethine 5 mg po q4 after hospitalization
>last week x4d on mag, then Brethine. Hospitalization was prompted by
>exceeding threshhold on home uterine monitoring. Treated for
>presumptive UTI ("contaminated specimen" but symptomatic). Cervical
>length is 30mm on TVUS, no change from two weeks ago. One OB called it
>25% effaced in hospital, but it's closed. Growth and development are
>maybe OK, but we're monitoring Doppler flows biweekly with peri because
>a few of our weekly u/s showed >20% discordance between Baby C and her
>siblings (who are size = dates). BP good, passed 1 hr glucose at 14 and
>28 weeks. HUAM generally 0-2 CTX/hour since on Brethine.
>
>My first questions are regarding the GBS culture done in the hospital.
>It came back "contaminated." What factors would lead to this result? In
>order to know how to rescedule, is it inappropriate to take the culture
>after KY's been added to the vagina (I usually get TVUS, then see OB)?
>
>Also, I'm getting confused because of mixed messages from the various
>OBs in my group and my perinatologists. I thought I'd try to get some
>opinions here, since I know that most of you rely on evidence over
>tradition.
>
>1) Some are telling me to minimize digital exams, and others are
>insistent on doing vigorous ones weekly. The exams do appear to
>increase contractions when the OB palpates the top of cervix rather than
>just checking for softening and external dilation. If the TVUS is
>showing no funnelling nor shortening, what's the benefit of palpating at
>the internal os? (And how might it change the plan of care?)
>
>2) I asked the OB I saw today how our plan of care would change if he
>detected funnelling, and he indicated a cerclage would be in order. I
>was shocked, as it seems late for this procedure; in addition, his
>partners and my peris indicated that the risk far outweighed the
>benefit. Is a cerclage really a reasonable option this late?
>
>3) Today's OB was very insistent on weekly steroid shots from now on,
>although this plan differed from that of his partners and my peris. On
>questioning about this difference, he said (I'm *sure* I heard this
>right) that the shots may be associated with an increased incidence of
>IVH. I thought the very opposite was true; has something changed?
>
>Sorry for the length and number of questions. The setup takes so long
>that I thought it might be easiest to ask all at once.
>
>With warm regards,
>
>--
>Patti Tessler
>
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