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Richard Chudacoff, MD, FACOG
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From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of R. Daniel
Braun
Sent: Wednesday, January 25, 2006 8:03 PM
To: Multiple recipients of list OB-GYN-L
Subject: 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
<mailto: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
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Barbara Nicol MD
St. Luke's Health Care Center
San Francisco CA USA
--
R. Daniel Braun
Kinky for Governor
