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Old April 18th 05, 05:04 AM
alath
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I'm trying to read between the lines here to clarify what some of your
concerns are.

I want CFM only at the onset of serious symptoms (ie, inability to

control
blood pressure despite adequate hypertensive therapy; deteriorating

liver
function; deteriorating renal function; progressive thrombocytopenia

or
neurological complications or imminent eclampsia) or heavy-duty

medication.

You seem to be saying here that you don't want fetal monitoring unless
you have severe pre-eclampsia. Am I getting that right? Of course all
these decisions are up to you, but I personally would want my wife to
have fetal monitoring if she had any pre-eclampsia (including mild).
Fetal compromise is one of the criteria that defines severe disease -
if you aren't looking for that, you won't know.

The clinical findings you list above are part of the definition of
severe pre-eclampsia. Once you get to this point - and I hope you don't
- fetal monitoring isn't really an issue any more because if you get
this sick, you need an expedited delivery (hopefully vaginal if you are
far enough along in labor, c-section if you are not). The additional
finding of fetal distress really wouldn't add much to the decision. In
other words, if you get this sick, you need to be delivered quickly no
matter what the fetal monitor says.

Do you use magnesium sulphate for convulsion prophylaxis?


What are your concerns here? Perhaps a better question would be, "under
what circumstances would you use mgso4 for seizure prophylaxis?"

What cutoff should we use for BP? (ASSHP suggest 170 systolic and/or

110
diastolic, but I am not sure my numbers got that high until I

actually
seized). What would you do if my BP did get too high?


Cut off for what? For the diagnosis of severe disease? For needing
antihypertensive medication?

"Eclampsia is a well recognised complication of the puerperium,

especially
when the guard of regular observations has been dropped. Some
abnormalities, particularly thrombocytopenia and platelet function

defects,
will often get worse during the first 2-3 days after delivery" -- how

will
this possibility be handled?


If you develop critical thrombocytopenia, you may be advised to have a
platelet transfusion.