Dear List: I haven't read any research beyond Dr. Brewers that replicates his
claims. I wish it were as simple as a good high protein diet as preventive
treatment for pre-eclampsia. I don't think that works for everyone, but that
doesn't mean it isn't worth trying. I think the web sites Tina gave us give a
good synopsis of abruptio placenta (too bad the site didn't have references)
and the Path Site gave some excellent slides. I think beyond PIH,
pre-eclampsia and gestational hypertension being causes of abruptio placenta
we have smoking, substance abuse and trauma (either accidental or
intentional) as being causes as well as unknown causes. I think the tricky
part with AP is when you have intermittent antepartal bleeding that is not
associated with pain. The midwife I was precepting with last year and myself
had a mum present with intermittent antepartal bleeding in the 3rd trimester,
we consulted with an OB and sent our mum for ultrasound, BPP, etc.. No
abruption was detectable, no previa etc., and baby was fine, so we waited for
labour. The mum wanted a home birth, which the OB did not condone (and quite
honestly I was not thrilled about), however the mum wanted to try at home so
she started her labour there with close surveillance, she did start to bleed,
not horribly and the baby was fine, but, she wasn't dilating, so we
transferred and when we got to the hospital the EFM picked up decels, mum had
a c/s, baby had apgars of 8/9 but had to be lavaged for blood, the placenta
was in the process of completely abrupting, mum's uterus also had a dehiscent
window but no rupture, all worked out well, but I thought it was a bit close,
for me. My preceptor was fine with it though and the parents were too.
Anyway, I do think antepartal bleeding in the third trimester is a good
indication for a hospital birth (even with previa ruled out). Marilyn
PS Sue I looked up PUB MED for the CRP (i was completely ignorant about it).
I entered C-reactive protein AND newborn respiratory distress and got a
lot of articles with informative abstracts. I seems that measurement of CRP
is used to differentiate between uncomplicated RDS and those with pneumonia,
aspiration, and extra pulmonary sepsis. The levels of CRP go up with the
onset of sepsis in Late Onset Sepsis. According to these articles the CRP is
elevated when above 10mg/L. CRP apparently is an anti-inflammatory agent
(acute phase reactant) and measurements are done in conjunction with
leucocyte counts and measurement is valuable in the diagnosis of neonatal
bacterial infection. I think Lois also said this, so I am being redundant
here. I hope the baby continues to do well.
regards marilyn
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