Re: Cytotec ripening/induction
From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)
Wed Sep 15 09:59:08 2004
I swear it is that simple. I used to place the Cytotec vaginally at 7,
rupture at noon and deliver at 5-7, however, using it orally is less time
intensive for me, prevents the patient from losing her bed by a drop in
(these patients are admitted just after midnight) and I now deliver at lunch
time rather than dinner time.
It always amazes me, and I've been using this for 6 years, how it manages to
work almost every time, like clock work.
One thing, the patients are 39 weeks or later. In these patients I use only
ONE cytotec, then rupture. For patients that need induction earlier for PIH,
oligo, or other indications sometimes I have to use two doses.
--
Richard Chudacoff, MD
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
RModugno@aol.com
Sent: Wednesday, September 15, 2004 7:50 AM
To: Multiple recipients of list OB-GYN-L
Subject: Cytotec ripening/induction
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
