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Re: new caseFrom: Luis Sanchez-Ramos, MD (sanchez-ramos@worldnet.att.net)Mon May 29 10:15:54 2000
At Sun, 28 May 2000, Betsy Hyde wrote: >>How can we say it was definitely due to the miso?<< That is exactly my point! This patient received OXYTOCIN after two doses of misoprostol. Once a patient receives a second uterotonic agent it is nearly impossible to determine which caused the uterine disruption. It is hard for me to believe that a patient with an unscarred uterus would suffer a catastrophic uterine rupture with two separate 25 mcg doses of misoprostol (adminestered to apatient who is not having regular uterine activity). There are currently 45 RCTs comparing the efficacy and safety of misoprostol with placebo or other active agents. The doses utilized have been from 25 to 100 mcg. Uterine ruptures have not been reported in these nearly 5000 randomized patients. For the most part (>99% had unscarred uteri). At our institution (>4000 labor inductions with misoprostol [50 mcg q'4-6 hrs]since 1992, we have seen 1 uterine rupture and it was due to the inappropriate administration of five 50 mcg doses to a patient with regular uterine activity). Dr. Carlan from Orlando has reported >100 cases of labor induction in patients with previous cesarean without a ruptured uterus. We have nearly 80 patients (RCT comparing misoprostol with oxytocin in patients with scarred uteri)again with no uterine ruptures. The cases described by Ms Hyde and those frequently mentioned by the group in Puerto Rico all have confounding factors: the former received an oxytocin infusion after receiving 2 doses of misoprostol and the latter two cases received repeat doses of misoprostol in spite of regular uterine activity and oxytocin infusion after PGE1 priming. I can understand one's eagerness to make public these occurrences. However, I wonder if they have the same interest informing us of ruptures occurring spontaneously or after the administration of other uterotonic drugs (PGE2, oxytocin)at their institutions?
-- Luis Sanchez-Ramos, MD
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