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'Do the logical thing' in managing preeclampsia.(Obstetrics)
KAILUA KONA, HAWAII -- Consider the worst thing that can happen when managing preeclampsia and then do the logical thing to avoid that outcome, Dr. Michael A. Belfort said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.
He highlighted some confusing aspects in current practice and gave his "logical" alternatives for managing mild and severe preeclampsia.
* Mild preeclampsia. Dr. Belfort challenged those who say that it is appropriate to delay delivery in a mildly preeclamptic patient with a preterm fetus (35-37 weeks' gestation). "We've got to get out of the mind-set that it's terrible to deliver somebody earlier than 37 weeks" in the face of a potentially disastrous disease process, he said at the conference sponsored by Boston University. At 35-37 weeks' gestation, deliver the baby if the benefits outweigh the risks to both mother and baby, he said.
He reminded the audience of the American College of Obstetricians and Gynecologists' recommendation to manage mild preeclampsia in the hospital initially, and he supported subsequent outpatient management under certain conditions. Ideally, patients managed on an outpatient basis should have a blood pressure monitor at home so that they can take measurements up to four times daily. The patient also needs clearly defined, written instructions for when to call the physician, he said. The frequency and type of prenatal surveillance in preeclamptic patients are areas open to clinical judgment. Weekly nonstress tests, biophysical profiles, or both, are recommended by ACOG, said Dr. Belfort, professor of obstetrics and gynecology at the University of Utah, Salt Lake City.
He suggested increasing the frequency of these tests in hospitalized patients. Dr. Belfort orders a nonstress test, amniotic fluid index, and lab tests every 3-4 days or more often depending on the clinical circumstances. If intrauterine growth restriction (IUGR) is identified in someone with preeclampsia beyond 32 ...
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Source: HighBeam Research, 'Do the logical thing' in managing preeclampsia.(Obstetrics)