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Old April 19th 05, 12:41 AM
Chookie
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In article .com,
"alath" wrote:

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.


Last time, I had severe disease without any fetal problems. I am one of the
44% of eclamptics who suffer it post-partum. DS was delivered at 41 wks and
weighed 8 lb 5 oz. This baby isn't showing any signs of trouble either -- in
fact, it's more active than DS was -- so I'm treating myself as a time bomb
and not worrying too much about the baby. My symptoms were high BP --
seizure, haemolysis, the standard liver & kidney problems, and
thrombocytopenia/DIC. The only symptom in labour was severe headache, and the
seizure occurred about 5 minutes pp.

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.


I don't want CFM *unless* augmentation of labour is indicated.

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?"


I heard that a large-scale trial of MgSO4 was taking place to see if it was
useful for preventing seizures in the first place -- it's definitely the drug
of choice for preventing *further* seizures. If anyone knows anythign about
this trial, I'm keen to hear about it -- couldn't spot it yet on Pubmed.

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?


Either.

"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.


Fortunately, my platelet function normalised rapidly last time, but I'd like
to see it monitored because of the rule of thumb about PE occurring later in
subsequent pregnancies.

IIRC, I had 2 units of *PRBCs* transfused, and as it still took 18 months for
my haemoglobin to return to normal, I assume the haemolysis was severe (I only
lost about 850 ml of blood).

Thanks for helping me clarify my thoughts!

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"In Melbourne there is plenty of vigour and eagerness, but there is
nothing worth being eager or vigorous about."
Francis Adams, The Australians, 1893.