Re: OB: Post Dates Inductions
From: Luis Sanchez-Ramos (sanchez-ramos@worldnet.att.net)
Sat Jul 18 20:55:26 1998
John;
The use of misoprostol is not associated with a higher incidence of
HYPERSTIMULATION. It has been noted to be associated with a higher
incidence of TACHYSYSTOLE (increased uterine activity without
alterations in the FHR).
How many RCTs (randomized clinical trials) are required before the
Society of Obstetricians and Gynaecologists of Canada accepts the use of
misoprostol for cervical ripening and labor induction ? At least 30 RCTs
have been published throughout the world since 1993. How many have been
published for other agents accepted by the Society in Canada ie,
Prepidil and Cervidil ? Only a handful (8 for Cervidil) and a few more
for Prepidil.
I don't think that such a statement in a neswletter should limit
Obstetricians in Canada to use such an effective agent.
Luis Sanchez-Ramos, MD
At Sat, 18 Jul 1998, John Robertson M.D. wrote:
>
>I am still waiting for further discussion, but to answer Luis, the
>Society of Obstetricians and Gynaecologists of Canada stated in one of
>their recent news letters that due to concerns about appropriate dosage
>and interval for misoprostil and possible hyperstimulation mysoprostil
>should only be used if part of a research trial at present.
>
>At Sat, 18 Jul 1998, Luis Sanchez-Ramos wrote:
>>
>>Since we started using intravaginal misoprostol for cervical ripening
>>and labor induction in 1993, we have had very few if any "failed
>>inductions"
>>Perhaps in Canada the use of misoprostol is not widespread inspite of 30
>>or more randomized clinical trials confirming its safety and efficacy.
>>Yes, there is a high incidence of tachysystole (6 or more uterine
>>contractions per 10 minute periods without the presence of fetal heart
>>rate abnormalities). However, the incidence of "hyperstimulation"
>>(tachysystole with FHR abnormalities) is no higher than with other labor
>>induction agents. In addition the need for oxytocin for augmentation in
>>the active phase of labor is markeldy reduced.
>>Intravaginally administered misoprostol at doses of 50 micrograms every
>>3-4 hours is an ideal agent for labor induction in post dates
>>pregnancies. The use of "serial inductions" with oxytocin or other
>>agents is a thing of the past.
>>
>>--
>>Luis Sanchez-Ramos, MD
>>
>>At Sat, 18 Jul 1998, John Robertson M.D. wrote:
>>>
>>>In most centres in Canada, inductions for post dates occur shortly after
>>>41 weeks. This is primarily as a result of the work by Hannah et al.
>>>looking at outcomes of induction vs foetal surveillance after term. I
>>>have found several instances where I have induced at 41+ weeks with 3
>>>doses of prostaglandin gel (usually the maximum we use), followed by
>>>syntocinon drip for 12 hours or more, and still have not had the patient
>>>in labour. At this point in time I have to decide wether to stop the
>>>induction and start again another day, press on with syntocinon in the
>>>face of no response, or perform a c-section.
>>>If I stop and start again, the question becomes - what changed that you
>>>felt you had to induce and deliver this baby yesterday, but now you feel
>>>waiting is OK? If I decide to use more syntocinon, at what point do you
>>>decide that there is not going to be any response, and there is starting
>>>to be some risk of water intoxication (hyponatremia etc.). If you
>>>decide to go to C/S what do you use as your indications? Interested in
>>>all opinions about the problem and also any potential solutions. John
>>>
>>>--
>>>J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
>>>(604) 793-9988 e-mail john.robertson@obgyn.net
>>>Who is wise and understanding among you? Let him show it by his good life,
>>>by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
>>>
>--
>J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
>(604) 793-9988 e-mail john.robertson@obgyn.net
>Who is wise and understanding among you? Let him show it by his good life,
>by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
>
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