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Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistake From: R. Daniel Braun (rd.braun@gmail.com) Wed Jan 25 19:02:07 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: Stillbirth" Previous message: cherivh@xdcr.com: "Re: Dionne Quins" In reply to: Barbara Nicol MD: "Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistake" Next in thread: Richard Chudacoff, MD: "Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistake" Reply: Richard Chudacoff, MD: "Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistake" Concur with Barbara. Rupturing membranes in a nullip with an unripe cervix before starting Oxytocin will lead to long ROM to del times and increased Chorio. When I start oxytocin in a nullip with an unripe cervix. I usually start at 2-4 mU/min and increase by a similar amount every 30 minutes until I get a good contraction pattern, then one has to watch very closely and turn it down as the labor develops and progresses. It takes a while for those oxytocin receptors to show up. In a G4 P3 who has reached 6 cm and stalled out, I will start at 0.5 mU/min and increase by the same amount every 45 minutes. She has receptors already and it doesn't take near as much. Dan On 1/25/06, Barbara Nicol MD <blnicol@ix.netcom.com> wrote: > > >However, I would refuse to start synto when the membranes were > still intact. > > Why? Works great and decreases your infection risk, which as you know is > closely associated with ROM-to-delivery interval. Yes, I know there is > evidence that amniotomy can speed time to delivery up by an hour or so, > but if prostaglandins are contraindicated and you've got an unripe > cervix, early ROM just increases the infection rate way out of > proportion to the speed of induction if you're only going to shorten the > ROM-to-delivery time by an hour. > > I've never understood why oxytocin is said by some to require ROM for > effectiveness or safety - is there some actual evidence around this > question? Uptodate claims that there's insufficient evidence to support > oxytocin plus ROM over oxytocin - perhaps someone knows of some other > evidence? > > Can't believe that I, the Yank MD, get to argue against an intervention > when you're arguing for it. <g> Oh, and those suction bulb things are > really good bath toys - much more powerful than the typical water pistol > - my kids played with theirs for years. > > - Barb > > -- > Barbara Nicol MD > St. Luke's Health Care Center > San Francisco CA USA > -- R. Daniel Braun Kinky for Governor Next message: R. Daniel Braun: "Re: Stillbirth" Previous message: cherivh@xdcr.com: "Re: Dionne Quins" In reply to: Barbara Nicol MD: "Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistake" Next in thread: Richard Chudacoff, MD: "Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistake" Reply: Richard Chudacoff, MD: "Re: Contemporary OB/GYN: Legally Speaking: The ME's million dollar mistake"

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