|
#691
05.09.2006, 19:36
|
||||
|
||||
|
Цитата:
 . Я вот только не знаю, рожать или не рожать, поэтому промолчу .
|
|
#692
05.09.2006, 19:50
|
||||
|
||||
|
С, нельзя рожать. Тем более что шейка long&closed.
|
|
#694
05.09.2006, 20:38
|
||||
|
||||
|
Мои познания в акушерстве оставляют желать лучшего, поэтому мне трудно ответить на вопрос – «рожать или не рожать?» Меня беспокоит нарушение зрения у пациентки, это может быть кровоизлияние, отслойка сетчатки или инсульт.
Пусть сначала окулист посмотрит, а потом можно определить тактику ведения родов. A. an emergent ophthalmology consult
|
|
#695
05.09.2006, 20:43
|
||||
|
||||
|
Мои тоже
 Только вот что я думаю: нужно нормализовать АД и родоразрешать. Рожать сама она будет долго (шейка не готова совсем), и все это время сохраняется (и возрастает) риск перехода преэклампсии в эклампсию со всякими renal failure, seizures, hemorrages etc. Поэтому - кесарево. А вот что я нашла про магнезию. [Magnesium sulphate for the management of preeclampsia][Article in French] Rozenberg P. Departement de gynecologie-obstetrique, centre hospitalier Poissy-Saint-Germain, universite de Versailles-Saint-Quentin, 10, rue du Champ-Gaillard, BP 3082, 78303 Poissy cedex, France. [Ссылки доступны только зарегистрированным пользователям ] In case of eclampsia, and especially in case of preeclampsia, no consensus exist in order to treat or to prevent convulsions by routine use of magnesium sulphate, at least in France. However, a large, multicentre, randomised trial compared the efficacy of magnesium sulphate with diazepam or phenytoin in eclamptic women. In this trial, magnesium sulphate was associated with a significantly lower rate of recurrent seizures and lower rate of maternal death than that observed with other anticonvulsants. The primary objective of magnesium sulphate prophylaxis in women with preeclampsia is to prevent or reduce the rate of eclampsia and complications associated with eclampsia. There are 3 large randomised controlled trials comparing the use of magnesium sulphate to prevent convulsions in patients with severe preeclampsia: the first one was vs phenytoin, the second vs placebo, and the third vs nimodipine. Patients receiving magnesium sulphate presented a significant lower risk of eclampsia than that observed with other comparison groups, probably by decreasing the cerebral perfusion pressure, thus avoiding a cerebral barotrauma. However, several arguments balance a wide use of magnesium sulphate: the prevalence of eclampsia in the Western world is very low, the use of magnesium sulphate does not affect the neonatal morbidity and mortality, and it is associated with a high rate of side effects, sometimes severe, such as respiratory depression. Thus, the benefit to risk ratio has to guide the use of magnesium sulphate and is directly correlated to the prevalence of eclampsia according to the risk of considered group. 1) The rate of seizures in women with mild preeclampsia not receiving magnesium sulphate is very low. Magnesium sulphate may potentially be associated with a higher number of adverse maternal effects. Therefore, the benefit to risk ratio does not support routine use of magnesium sulphate prophylaxis in this group. 2) On the other hand, the higher rate of seizures in women with severe preeclampsia (2.0%), especially in those who have imminent eclampsia, justifies prophylaxis with magnesium sulphate. PMID: 16406662 [PubMed - indexed for MEDLINE]
|
|
#697
05.09.2006, 20:49
|
||||
|
||||
|
Я же сначала ответила
 К тому же про то, можно рожать или нельзя, так и не встретилось, было в лом копаться.
|
|
#699
05.09.2006, 21:10
|
||||
|
||||
|
Williams Obstetrics, 22nd Edition
Chapter 34. Hypertensive Disorders in Pregnancy Preeclampsia. Management Basic management objectives for any pregnancy complicated by preeclampsia are: Termination of pregnancy with the least possible trauma to mother and fetus. Birth of an infant who subsequently thrives. Complete restoration of health to the mother. In certain women with preeclampsia, especially those at or near term, all three objectives are served equally well by induction of labor. Therefore, the most important information that the obstetrician has for successful management of pregnancy, and especially a pregnancy that becomes complicated by hypertension, is precise knowledge of the age of the fetus. Delivery is the cure for preeclampsia. Headache, visual disturbances, or epigastric pain are indicative that convulsions may be imminent, and oliguria is another ominous sign. Severe preeclampsia demands anticonvulsant and usually antihypertensive therapy followed by delivery. Elective Cesarean Delivery Once severe preeclampsia is diagnosed, the obstetrical propensity is for prompt delivery. Labor induction to effect vaginal delivery has traditionally been considered to be in the best interest of the mother. Several concerns, including an unfavorable cervix precluding successful induction of labor, a perceived sense of urgency because of the severity of preeclampsia, and the need to coordinate neonatal intensive care, have led some practitioners to advocate cesarean delivery. Alexander and colleagues (1999) reviewed 278 singleton liveborn infants weighing 750 to 1500 g delivered of women with severe preeclampsia at Parkland Hospital. Half of the women had labor induced and the remainder underwent cesarean delivery without labor. Induction was not successful in 35 percent of the women in the induced group, but it was not harmful to their very low-birthweight infants. Similar results were reported by Nassar and colleagues (1998).
|
|
#700
05.09.2006, 21:11
|
|||
|
|||
|
По правилам российских акушеров при преэклампсии обеспечиваем покой, снижаем давление,предотвращаем судороги (магнезия), родоразрешаем (при отсутствии готовности родовых путей - кесарим). Осмотр глазного дна принципиально на тактику не повлияет, так же как и УЗИ.
Вероятно верно C.
|
|
#701
05.09.2006, 21:15
|
||||
|
||||
|
Все-таки скорее всего- С.В первую очередь снизить давление и готовить к кесареву.Офтальмологу,конечно ,надо показать срочно,но сначала снизить давление.
|
|
#703
05.09.2006, 21:22
|
|||
|
|||
|
Цитата:
|
|
#704
05.09.2006, 21:23
|
||||
|
||||
|
По поводу магнезии из того же Уильямса:
Magnesium Sulfate to Control Convulsions In more severe cases of preeclampsia, as well as eclampsia, magnesium sulfate administered parenterally is an effective anticonvulsant agent without producing central nervous system depression in either the mother or the infant. It may be given intravenously by continuous infusion or intramuscularly by intermittent injection (Table 34–7). The dosage schedule for severe preeclampsia is the same as for eclampsia. Because labor and delivery is a more likely time for convulsions to develop, women with preeclampsia–eclampsia usually are given magnesium sulfate during labor and for 24 hours postpartum. Table 34–7. Intravenous and Intramuscular Magnesium Sulfate Dosage Schedules for Severe Preeclampsia and Eclampsia Continuous Intravenous Infusion 1. Give 4- to 6-g loading dose of magnesium sulfate diluted in 100 mL of IV fluid administered over 15–20 min. 2. Begin 2 g/hr in 100 mL of IV maintenance infusion. 3. Measure serum magnesium level at 4–6 hr and adjust infusion to maintain levels between 4–7 mEq/L (4.8–8.4 m/dL). 4. Magnesium sulfate is discontinued 24 hr after delivery. Intermittent Intramuscular Injections 1. Give 4 g of magnesium sulfate (MgSO4· 7H2O USP) as a 20% solution intravenously at a rate not to exceed 1 g/min. 2. Follow promptly with 10 g of 50% magnesium sulfate solution, one-half (5 g) injected deeply in the upper outer quadrant of both buttocks through a 3-inch-long, 20-gauge needle. (Addition of 1.0 mL of 2%lidocaine minimizes discomfort.) If convulsions persist after 15 min, give up to 2 g more intravenously as a 20% solution at a rate not to exceed 1 g/min. If the woman is large, up to 4 g may be given slowly. 3. Every 4 hr thereafter give 5 g of a 50% solution of magnesium sulfate injected deeply in the upper outer quadrant of alternate buttocks, but only after ensuring that: a. the patellar reflex is present b. respirations are not depressed c. urine output the previous 4 hr exceeded 100 mL Magnesium sulfate is discontinued 24 hr after delivery. Clinical Efficacy of Magnesium Sulfate Therapy The multinational Eclampsia Trial Collaborative Group (1995) study was funded in part by the World Health Organization and coordinated by the National Perinatal Epidemiology Unit in Oxford, England. This study involved 1687 women with eclampsia who were randomly allocated to different anticonvulsant regimens. In one study, 453 women were randomly given magnesium sulfate and compared with 452 given diazepam. Another 388 eclamptic women were randomly given magnesium sulfate and compared with 387 women given phenytoin. Women allocated to magnesium sulfate therapy had a 50-percent reduction in recurrent seizures compared with that in those given diazepam. Importantly, maternal deaths were reduced in women given magnesium sulfate, and although these differences are clinically impressive, they are not statistically significant. Specifically, there was a 3.8-percent death rate in 453 women randomly allocated to magnesium sulfate compared with a 5.1-percent rate in 452 given diazepam. Maternal and perinatal morbidity were not different between these two groups, and there was no difference in the number of labor inductions or cesarean deliveries. In other comparisons, women allocated to magnesium sulfate therapy were less likely to be artificially ventilated, to develop pneumonia, and to be admitted to intensive care units than those given phenytoin. Neonates of women given magnesium sulfate were significantly less likely to require intubation at delivery and to be admitted to the neonatal intensive care unit compared with infants whose mothers received phenytoin. The Collaborative Group concluded: "There is now compelling evidence in favour of magnesium sulfate, rather than diazepam or phenytoin, for the treatment of eclampsia." These results are even more impressive when it is emphasized that women in this study who received intravenous magnesium sulfate received only 1 g per hour!
|
|
#705
05.09.2006, 21:30
|
||||
|
||||
|
Цитата:
Once severe preeclampsia is diagnosed, the obstetrical propensity is for prompt delivery. Labor induction to effect vaginal delivery has traditionally been considered to be in the best interest of the mother. Several concerns, including an unfavorable cervix precluding successful induction of labor, a perceived sense of urgency because of the severity of preeclampsia, and the need to coordinate neonatal intensive care, have led some practitioners to advocate cesarean delivery. Alexander and colleagues (1999) reviewed 278 singleton liveborn infants weighing 750 to 1500 g delivered of women with severe preeclampsia at Parkland Hospital. Half of the women had labor induced and the remainder underwent cesarean delivery without labor. Induction was not successful in 35 percent of the women in the induced group, but it was not harmful to their very low-birthweight infants. Similar results were reported by Nassar and colleagues (1998).
|
Линейный вид
