Re: cervical ripening
From: Efrain Ramirez (eramirez@icepr.com)
Wed Feb 28 04:56:15 2001
There should be a Joint Conference Committee in your hospital
(administration and faculty) you seat down with them and explain the
whole issue - you must be able to convince them - the evidence is huge.
At Tue, 27 Feb 2001, Ira Bachman, MD wrote:
>
>I would like to use misoprostol, but have met resistance from the
>administration. They seem to value Searle's opinion more than ACOG's.
>At Tue, 27 Feb 2001, Luis Sanchez-Ramos, MD wrote:
>>
>>Ira:
>>
>>My recommendation is to use misoprostol: it ripens the cervix and
>>induces uterine activity and it is very economical. Multiple doses of
>>Cervidil would be very costly. The literature regarding the use of
>>Cervidil is sparce. There are numerous articles assessing the efficacy
>>of dinoprostone (PGE2)but most of these studies deal with the
>>intravaginal administration of PGE2. Many studies also assessed the
>>efficacy of intracervical administration of dinoprostone, i.e, Prepidil
>>as well as hospital compounded products. Now, with regard to (slow
>>release 10 mg vaginal insert of PGE2) Cervidil; not many studies are
>>available. It was approved by the FDA based on the "other" PGE2 studies
>>and effectiveness compared to placebo. We performed a meta-analysis
>>comparing Cervidil with misoprostol and showed that the latter was more
>>effective and cheaper.
>>
>>LSR
>>
>>At Tue, 27 Feb 2001, Ira Bachman, MD wrote:
>>>
>>>Maybe Luis can help. I believe he has published quite a bit on cervical
>>>ripening.
>>>At Tue, 27 Feb 2001, Braun, R. Daniel wrote:
>>>>
>>>> I am not aware of any literature. One of our MFM's does it however and he
>>>>swears by it. He is not aware of any literature either.
>>>>
>>>>Dan
>>>>
>>>>-----Original Message-----
>>>>From: awogc@aol.com
>>>>To: Multiple recipients of list OB-GYN-L
>>>>Sent: 2/27/2001 4:45 PM
>>>>Subject: cervical ripening
>>>>
>>>>In an effort to lower the cesarean section rate in our hospital, the
>>>>department director recommended more use of cervidil. He stated that if
>>>>one dose doesn't work (improve your bishop score) try a second or a
>>>>third.
>>>>Is anyone aware of any literature that demonstrates that multiple doses
>>>>work better than one dose?
>>>>I've serached,but haven't found anything.
--
"Life is neither the notes nor the silence between the notes, but the music that
arises out of sound and silence felt as a living whole. Stop choosing...between
chaos and order, and live at the boundary between them, where rest and action
move together..." David Whyte
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