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Cytotec ripening/inductionFrom: RModugno@aol.comWed Sep 15 08:49:21 2004
Garry, This is from the package insert: "Labor and delivery: Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony. A major adverse effect of the obstetrical use of Cytotec is the hyperstimulation of the uterus which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported. There may be an increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec, including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity also appears to be a risk factor for uterine rupture. The effect of Cytotec on later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labor have not been established. Information on Cytotec's effect on the need for forceps delivery or other intervention is unknown." Also, ACOG has a commitee opinion on cytotec which is on the ACOG website. As you know your "minor/large" hospital has protocols for both oral and vaginal cytotec for ripening/induction. The "logistics" has to do with the problem of timing of delivery. As Rick says: cytotec in @3.am, amniotomy& pitocin @ 8.0am, deliver at noon. Is it really that simple, Rick? Robert Modugno MD MBA FACOG Marietta, GA http://www.novaobgyn.yourmd.com
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