Re: Cytotec and postpartum hemorrhage
From: Glen Elrod MD (glen.elrod@elmendorf.af.mil)
Thu Jul 17 16:37:43 2003
Actually, pt did quite well after surgery. We ended up giving 200 ug
cytotec po initially and then 100ug every 4 hours for the first 8 hours
after the bleeding started. I have NO basis for the choice of dose or
interval but since I knew that methergine and hemabate were definately
contraindicated it seemed a reasonable choice. H/H settled out at
8.5/25 by POD#2. Mom and baby should be going home tomorrow.
Glen
At Thu, 17 Jul 2003, Terrence.Jones@kp.org wrote:
>
>This is a multipart message in MIME format.
>--=_alternative 006F07D988256D66 Content-Type: text/plain; charset="us-ascii"
>
> Think the meds were available (Elmendorf AFB). Think they just
>didn't want to use hemabate with asthma hx (more a precaution than
>contraindx), nor methergine with inc bp. Have seen cytotec work well here,
>but limited numbers... If still open (ie: atony) there's always"B-Lynch"
>(BJOG 3/97; with modification: O/G 3/02) along with foley tamponade
>(Danso, BJOG 8/02). "Rare association" of cytotec with
>bronchospasm/dyspnea - tho no causal association either confirmed or
>negated. OTOH, one gets a certain degree of dyspnea as the HCT drops into
>the 'teens'. tj
>
>eramirezt@coqui.net (Efrain Ramirez)
>Sent by: ob-gyn-l@obgyn.net
>07/17/2003 12:29 PM
>Please respond to ob-gyn-l
>
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> cc:
> Subject: Re: Cytotec and postpartum hemorrhage
>
>Haven't heard it is contraindicated in asthmatics - !
>
>If there is no Hamabate - you can use it - rectally or/and PO - I dont
>think it is as good as Methergine or Hemabate.
>
>At Thu, 17 Jul 2003, Braun, R. Daniel wrote:
>>
>>Cytotec is also a prostaglandin. Can't use in asthmatics either.
>>
>>We use it after C/S. It is our second choice after pitocin.
>>
>>-----Original Message-----
>>From: Glen Elrod MD [mailto:glen.elrod@elmendorf.af.mil]
>>Sent: Thursday, July 17, 2003 10:41 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Cytotec and postpartum hemorrhage
>>
>>Does anyone have any experience with Cytotec and postpartum hemorrhage
>>in women that have just undergone a c-section. I know that Cytotec is
>>contraindicated in women with a previous c-section for labor induction.
>>I have used cytotec rectally for women with vaginal deliveries that have
>>postpartum hemorrhage.
>>
>>The reason this came up is we have a postpartum c/s that is diabetic,
>>asthmatic, preeclamptic with a postpartum hemorrhage. Methergine is
>>out. Hemabate is out. Pitocin was running. Pt is now several hours
>>out from surgery. Any other suggestion?
>>
>>Thanks,
>>
>>Glen
>>
>>--
>>D. Glen Elrod, Maj, USAF, MC
>>Medical Director
>>Women's Health Clinic
>>Elmendorf AFB, AK 99506
>>
>--
>"The opposite of a correct statement is a false statement.
>But the opposite of a profound truth may well be another profound truth."
>
>Niels Bohr (1885 - 1962)
>
>--=_alternative 006F07D988256D66 Content-Type: text/html; charset="us-ascii"
>
><br><font size=2 face="sans-serif"> Think the meds were available (Elmendorf AFB). Think they just didn't want to use hemabate with asthma hx (more a precaution than contraindx), nor methergine with inc bp. Have seen cytotec work well here, but limited numbers... If still open (ie: atony) there's always"B-Lynch" (BJOG 3/97; with modification: O/G 3/02) along with foley tamponade (Danso, BJOG 8/02). "Rare association" of cytotec with bronchospasm/dyspnea - tho no causal association either confirmed or negated. OTOH, one gets a certain degree of dyspnea as the HCT drops into the 'teens'. tj</font>
><br>
><table width0%>
><tr valign=top>
><td>
><td><font size=1 face="sans-serif"><b>eramirezt@coqui.net (Efrain Ramirez)</b></font>
><br><font size=1 face="sans-serif">Sent by: ob-gyn-l@obgyn.net</font>
><p><font size=1 face="sans-serif">07/17/2003 12:29 PM</font>
><br><font size=1 face="sans-serif">Please respond to ob-gyn-l</font>
><br>
><td><font size=1 face="Arial"> </font>
><br><font size=1 face="sans-serif"> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net></font>
><br><font size=1 face="sans-serif"> cc: </font>
><br><font size=1 face="sans-serif"> Subject: Re: Cytotec and postpartum hemorrhage</font></table>
><br>
><br><font size=2 face="Courier New">Haven't heard it is contraindicated in asthmatics - !<br>
><br>
>If there is no Hamabate - you can use it - rectally or/and PO - I dont<br>
>think it is as good as Methergine or Hemabate.<br>
><br>
>At Thu, 17 Jul 2003, Braun, R. Daniel wrote:<br>
>><br>
>>Cytotec is also a prostaglandin. Can't use in asthmatics either.<br>
>><br>
>>We use it after C/S. It is our second choice after pitocin.<br>
>><br>
>>-----Original Message-----<br>
>>From: Glen Elrod MD [mailto:glen.elrod@elmendorf.af.mil]<br>
>>Sent: Thursday, July 17, 2003 10:41 AM<br>
>>To: Multiple recipients of list OB-GYN-L<br>
>>Subject: Cytotec and postpartum hemorrhage<br>
>><br>
>>Does anyone have any experience with Cytotec and postpartum hemorrhage<br>
>>in women that have just undergone a c-section. I know that Cytotec is<br>
>>contraindicated in women with a previous c-section for labor induction.<br>
>>I have used cytotec rectally for women with vaginal deliveries that have<br>
>>postpartum hemorrhage.<br>
>><br>
>>The reason this came up is we have a postpartum c/s that is diabetic,<br>
>>asthmatic, preeclamptic with a postpartum hemorrhage. Methergine is<br>
>>out. Hemabate is out. Pitocin was running. Pt is now several hours<br>
>>out from surgery. Any other suggestion?<br>
>><br>
>>Thanks,<br>
>><br>
>>Glen<br>
>><br>
>>--<br>
>>D. Glen Elrod, Maj, USAF, MC<br>
>>Medical Director<br>
>>Women's Health Clinic<br>
>>Elmendorf AFB, AK 99506<br>
>><br>
><br>
>--<br>
>"The opposite of a correct statement is a false statement. <br>
>But the opposite of a profound truth may well be another profound truth."<br>
><br>
>Niels Bohr (1885 - 1962)<br>
></font>
><br>
>
--
D. Glen Elrod, Maj, USAF, MC
Medical Director
Women's Health Clinic
Elmendorf AFB, AK 99506
|
|
