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Re: A few things (Misoprostol protocol)From: dahmd@gate.netWed Mar 19 16:23:06 1997
In article elvis@llano.net (Michael J. Wolpmann, M.D.) writes:
>Ashley, Michael- Here are the main points: 1. 50 micrograms in posterior fornix every 4 hours. 2. Use continuous fetal monitoring. Contraindications: 1. Unexplained vaginal bleeding. 2. Prior classical c/section or extensive myomectomy, anomaly repair, etc. 3. Greater than 10 contractions/hour. 4. Bishop's score greater than 7. 5. Malpresentation, previa, etc (any regular contraindication to induction). 6. Relative: greater than 6 previous pregnancies. We have used this, after informed consent, in patients with prior low transverse c/section. I have not heard of any uterine ruptures or other significant problems using this protocol, but we have had this for only about 6-8 months. It has subjectively dramatically improved the time to delivery and induction success rate, and I'm waiting for the pregnant nurses to take some home to induce labor when they hit 38 weeks :)
>Also, how did you arrive at 600mcg's for the IUFD? Just curious if this This was one dose. Our former perinatologist used this dose in patients with fetal demise (please note this patient did not get misoprostol for the fetal delivery, only for the placenta) and gave it every 6-8 hours. It never took more than 3 doses, and usually took just one. I picked the 600 microgram dose based solely on my conversations with him, another perinatologist I trust, and my experiences with this dosage in our hospital. (Now, to the medline for a search)! Thanks, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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