Re: cervical ripening
From: art fougner, md (evsono@pipeline.com)
Wed Feb 28 08:05:25 2001
Efrain -
evidence is huge but $$$$ trumps evidence.
art
At Wed, 28 Feb 2001, Efrain Ramirez wrote:
>
>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
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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