Re: cervical ripening
From: Efrain Ramirez (eramirez@icepr.com)
Wed Feb 28 20:53:57 2001
True - but you must try -- the best you can.
At Wed, 28 Feb 2001, art fougner, md wrote:
>
>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.
>
--
"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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