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Re: 20 wk IUP, megacystis, anhydramnios, gender unknown From: steve (steve@dhngwe2.db.healthlink.org.za) Mon Apr 3 03:05:30 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: steve: "(Fwd) Re: DUB" Previous message: mark decker: "Re: Clomid therapy" You can't induce someone at that gestation with that small amount of misoprostol. You need to give a wbole 200 mcg tablet at 8 - 12 hour intervals. If that fails then give 400 mcg. Below 20 weeks I have sometimes found it necessary to give as much as 800 mcg And, yes I agree with the induction. I leave it up to the patient to decide when. But once you've started you shouldn't stop - it's terribly demoralising. Just keep increasing the dose until something happens. I personally think a better alternative to laminaria is the intra-amniotic PgF2alpha, if by remote chance you fail with PgE1. > 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 > > 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. -- Steve Raymond Dr. S.H. Raymond Head of Department of O & G Empangeni Hospital EMPANGENI South Africa 3880 Ph. (27)+(35)7721111 Fax (27)+(35)7922596 Next message: steve: "(Fwd) Re: DUB" Previous message: mark decker: "Re: Clomid therapy"

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