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Re: Cytotec ripening/induction From: RModugno@aol.com Thu Sep 16 19:04:40 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Betsy Hyde: "Re: Cytotec ripening/induction" Previous message: Marie Harkins: "Re: Cytotec ripening/induction" Maybe in reply to: RModugno@aol.com: "Cytotec ripening/induction" Next in thread: Braun, R. Daniel: "Re: Cytotec ripening/induction" In a message dated 9/16/2004 7:17:48 PM Eastern Daylight Time, Marie Harkins <mharkins@twcny.rr.com> writes: >I was wondering how folks are monitoring women after cytotec.  Some >practitioners here use 25mcg vaginally, monitor for 2 hours and then >either continue with ripening or discharge home to return tomorrow.   >There has been some debate as to whether this is appropriate. > >My brother, an Ob Gyn who has practiced in other parts of the country, >says that discharging women home after two hours of monitoring is way >out of line with what others are doing.  He says that there have been >cases of hyperstimulation as much as 9 hours after placement of cytotec >(not sure what dose that was).  There would be no way to defend >yourself if something like that happened after you sent a woman home.   >I have not been able to find documentation to back this up. > >I would love to hear how some of you routinely use this. > >Marie Harkins, CNM >Ithaca, NY > Funny you should ask Marie - this is from the September Green Journal: Misoprostol Outpatient Cervical Ripening Without Subsequent Induction of Labor: A Randomized Trial David S. McKenna, MD, John B. Ester, MD, Michael Proffitt, MD and Kevin R. Waddell, MD >From the Department of Obstetrics and Gynecology, Wright State University and Wright-Patterson U.S. Air Force Medical Center, Dayton, Ohio. OBJECTIVE: To estimate the effect of outpatient administration of a single dose of vaginal misoprostol at term on the interval to delivery in women with unfavorable cervices. METHODS: Randomized, double blind, placebo-controlled trial comparing a single 25-µg outpatient intravaginal dose of misoprostol to placebo in pregnant women with Bishop scores less than 9 at 40 weeks or greater. After placement of the study medication, subjects were permitted to go into spontaneous labor unless an indication for induction developed. Analysis was by intent to treat. The interval to delivery, defined as the time from medication placement to delivery, was compared by Student t test and by survival analysis with the log-rank test. RESULTS: Thirty-three women were randomly assigned to receive misoprostol, and 35 were assigned to receive placebo. The mean interval to delivery was significantly less in the misoprostol group, 4.2 ± 4.1 compared with 6.1 ± 3.6 days, P = .04. The interval to delivery for only the nulliparous patients was significantly less in the misoprostol group, 4.2 ± 4.0 compared with 7.2 ± 3.7 days, P = .02. The survival curves for the interval to delivery were significantly different (P = .04 by log-rank test) with 4.1 days median interval to delivery for misoprostol compared with 9.2 days for placebo. There were no adverse outcomes in either group. CONCLUSION: A single 25-µg outpatient intravaginal dose of misoprostol is effective in decreasing the interval to delivery in women with unfavorable cervices at term. LEVEL OF EVIDENCE: I Robert Modugno MD MBA FACOG Marietta, GA http://www.novaobgyn.yourmd.com Next message: Betsy Hyde: "Re: Cytotec ripening/induction" Previous message: Marie Harkins: "Re: Cytotec ripening/induction" Maybe in reply to: RModugno@aol.com: "Cytotec ripening/induction" Next in thread: Braun, R. Daniel: "Re: Cytotec ripening/induction"

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