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Re: new case From: Luis Sanchez-Ramos, MD (sanchez-ramos@worldnet.att.net) Wed May 31 18:35:05 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel: "Re: new case" Previous message: Joanne Bulley, MD: "Re: new case" In reply to: Garry E. Siegel: "Re: new case" Next in thread: Garry E. Siegel: "Re: new case" Reply: Garry E. Siegel: "Re: new case" Garry: As I have stated on other occasions, many patients, mainly the obese, have contractions with PGs which they don't feel. These "mild" but frequently occuring contractions are frequently not picked up by external monitoring. If a repeat dose of misoprostol is given to these patients, it often results in tachysystole or even hyperstimulation. My recommendation would be to use IUPCs in obese patients or in patients without apparent uterine activity after receiving one or modre doses of PGE1 (unless you are 100% convinced that the patient is not experiencing uterine activity). LSR At Tue, 30 May 2000, Garry E. Siegel wrote: > >Luis: > >For those who use miso for induction, what criteria are used to exclude >or allow the subsequent doses? For instance, our protocol says 8 >contractions/hour means no next dose, irrespective of the intensity >(IUPCs are rarely in). Thus, most patients contract "some" after the >first dose, and don't get many second ones at 4 to 6 hours. > >So, it is 6 hours later--do we re-dose, start pit, ignore? > >A bit of practical advice would be helpful. > >Thanks > >Garry >> >>Here lies the problem: we have to accept, without objective evidence, >>that the patient was having "minimal" contractions prior to receiving >>misoprostol. How do you define minimal contractions. I have seen a >>number of patients with "mininmal" contractions or apparently without >>contractions than when an IUPC was inserted were noted to have regular >>uterine activity (At least 3 contractions per 10 minutes). Why don't >>you scan the monitor strip for us so that we can determine or quantify >>uterine activity? >> >>LSR > >-- >Garry E. Siegel, M.D., F.A.C.O.G. >Private Practice >Roswell, GA > Next message: Garry E. Siegel: "Re: new case" Previous message: Joanne Bulley, MD: "Re: new case" In reply to: Garry E. Siegel: "Re: new case" Next in thread: Garry E. Siegel: "Re: new case" Reply: Garry E. Siegel: "Re: new case"

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