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Re: Cytotec and postpartum hemorrhageFrom: Barbara Nicol MD (blnicol@ix.netcom.com)Thu Jul 17 14:37:30 2003
If you do a quick Medline on misoprostol and bronchospasm you will find that inhaled misoprostol is being studied to _treat_ asthma because it _prevents_ bronchospasm. (OK, granted, it's a guinea pig model, but it just goes to show that we shouldn't lump all prostaglandins together and assume they all have the same side effects.) I am not aware of data showing a link between misoprostol and bronchospasm (other than preventing it) but I'm always willing to learn more if someone does have some evidence. It also makes sense to me that it would be OK to use in the postpartum setting even in patients with prior CS. If the proportionately rather large doses of pitocin (10s of units instead of 10s of milliunits) which are usually given for postpartum hemorrhage don't cause rupture in the nonpregnant uterus, it doesn't make sense that misoprostol would either. As always, it's a balance of risks - but it sounds like your other choice might involve return to the OR. Best wishes with a very difficult-sounding case. I hope all goes well.
-- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA
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