Re: Cytotec ripening/induction
From: art fougner, md (evsono@pipeline.com)
Wed Sep 15 10:38:18 2004
Rich ...
i look forward to your article in Contemporary Ob-Gyn or The Female
Patient.
art
At Wed, 15 Sep 2004, Richard Chudacoff, MD wrote:
>
>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
>
--
art fougner, md
ich bin ein New Yorker
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