Re: A few things (Misoprostol protocol)
From: Richard M. Chudacoff, MD (richardc@bcm.tmc.edu)
Wed Mar 19 16:38:56 1997
What ever happened to the protocol that was on the OBGYN.net home page?
At Wed, 19 Mar 1997, dahmd@gate.net wrote:
>
>In article elvis@llano.net (Michael J. Wolpmann, M.D.) writes:
>
>>Ashley,
>>Do you have a protocol in your hospital for misoprostol?
>>Can you email a copy if so? Thanks.
>
>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
>>was one dose or repeated dosing?
>
>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
--
Richard Chudacoff, MD
Baylor College of Medicine
BaylorMedCare
Houston/Richmond, TX
"Mars is essentially in the same orbit... Mars is somewhat the same
distance from the Sun, which is very important. We have seen pictures where
there are canals, we believe, and water. If there is water, that means
there is oxygen. If oxygen, that means we can breathe."
--Former Vice President Dan Quayle
