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Re: 20 wk IUP, megacystis, anhydramnios, gender unknownFrom: dr. peterman (peterman@proteus.com)Thu Mar 30 21:43:13 2000
On this patient (21 week IUP with bladder outflow obstruction and severe oligohyrdamnios), serial fetal urinalyses revealed absent renal function (renal dysplasia). She is therefore not a candidate for vesico-amniotic shunt. Anhydraminos persists. The patient elected to undergo labor induction (she does not want a D&E because of personal beliefs). That induction, which included 5 doses of misoprostol (50mcg) over the course of 24 hours and high dose pitocin (max of 400mU/min) for 10 hours, failed. She has elected to go home and return in several weeks to attempt induction again. She does not want to undertake prolonged expectant management because she does not want to deliver a near-term and term infant and watch it expire and she will not consent to a D&E. I would be very interested to know what other clincians would do with this patient at this point. When would you bring her back for another trial of induction? How many times would you do this (serial induction)? Pitocin receptors should start to upregulate by 22-16 weeks. I have contemplated Laminaria or a foley for cervical dilation, but she has not had any uterine activity. I am therefore concerned that if I do dilate her mechanically, and if she subsequently fails induction, she may develop chorioamnionitis. Then I have a septic problem, and I don't like doing D&E's on an infected uterus. p.peterman.
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