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Re: A few thingsFrom: dahmd@gate.netSun Mar 16 09:28:41 1997
>RSchnei487@aol.com wrote:
>> Is anyone using CYTOTEC for cervical ripening?? We use 50 micrograms of misoprotol in the posterior fornix every 4 hours until the cervix is "ripe" or until regular contractions (greater than 6-8 per hour) occur. A recent report in Obstetrics and Gynecology (Kramer et al, 1997; 89(3):387-391) reported on 100 micrograms in a similar regimen compared to IV oxytocin, with a signficantly decreased time to delivery (585 versus 885 minutes). They reported that 70% of misoprostol patients developed tachysystole. We only rarely see this at the 50 microgram dosage. Wing et al (AJOG 1995;172:1804-1810) reported tachysystole in about 37% of patients receiving 50 micrograms, but, again, we have not seen many problems with this. However, we provide continuous fetal monitoring in all our patients receiving misoprostol. The bottom line is the stuff works very well for cervical ripening, and many patients do not need oxytocin. Finally, I had a patient recently with an 18 week fetal death in utero who rapidly progressed through labor and delivered the fetus, but did not deliver the placenta. Oxytocin and time did not help. I gave her 600 micrograms of misoprostol and she delivered the placenta 30 minutes later. There were no side-effects in this "series of one".
>> When are you inducing for post dates 41 or 42 weeks?? A harder question. My partners and I do a cervical exam and offer induction (after discussing risks:benefits) at 41 weeks if the cervix is favorable. If unfavorable, we begin twice weekly NSTs and once weekly ultrasound for amniotic fluid index and fetal weight. (If the amniotic fluid index is low-normal we may perform an ultrasound more often). At 42 weeks we encourage induction whether or not the cervix is favorable, and most patients agree to this. If not, then we continue fetal surveillance as discussed above until labor, or until low amniotic fluid or a non-reassuring NST, etc. Again, however, about 99.9% of patients want an induction by 42 weeks in our practice! Thanks, Ashley D. Ashley Hill, M.D. Assistant Director Dept. of Ob/Gyn Florida Hospital Family Practice Residency Orlando, FL dahmd@gate.net
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