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Misoprostol-MiscFrom: Luis Sanchez-Ramos, MD (sanchez-ramos@worldnet.att.net)Tue Oct 31 20:55:06 2000
I am also very pleased with the ACOG news release of 10/27/00 supporting the use of misoprostol. I am surprised that the ACOG Committee on Obstetric Practice and Stanley Zinberg chose a meta-analysis by Hofmyer as their evidence for support. Perhaps they didn't realize that my most recent systematic review included 44 RCTs compared to 27 RCTs in the Cochrane Databas. I guess they figured that the name "Cochrane" would carry more weight with the FDA. On another note: the most recent publication in Obstet Gynecol (November issue) on the outpatient use of misoprostol for cervical ripening should have been entitled: "Misoprostol for Outpatient Labor Induction" I have always felt that misoprostol is not a cervical ripening agent..like oxytocin, it is a labor induction agent. I have not completed my full evaluation of the study but I saw enough to disturb me. 24 of 27 patients in the misoprotol arm delivered within 48 hours. In other words many of these patients labored at home, not monitored. The danger of this protocol was limited by the small sample size. You can get away with outpatient "labor induction" in 27 patients but not with many more. I would like to hear the opinion of others. LSR
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