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Re: Cytotec vs. Cervidil

From: Christopher (anonymous@obgyn.net)
Thu, 11 Feb 1999 09:03:22 -0500

>>Karen
>
>Neither you nor your midwife may like my answer. Cervidil is a good
>system, but Cytotec is better, cheaper, faster, and safer (the last is
>my own opinion, though I think it is supportable in the literature).
>Frankly the two have slightly different indications, also in my opinion.
>Cervidil is good for ripening an unripe cervix. The fact that you
>delivered so quickly with it tells me that your baby needed just the
>smallest nudge to hit the road so to speak. Cytotec takes you to
>contractions faster, as well as ripening the cervix. The time to labor,
>and the time to delivery are shorter, with no increase in complications.
>You can also dose more frequently if necessary.
>
>I do not understand being afraid to use Cytotec for a VBAC, when she
>appears to be willing to use the other agents. There are those that
>will not use any agent for a VBAC, but all agents have the same results,
>contractions. If you are willing to use one, you should be willing to
>use the others, at least in principle.
>
>Pitocin is not a good agent for use with an unripe cervix, but if you
>are contracting, the other two agents are contraindicated. Plus,
>pitocin (after all, this is the very hormone your own body makes to have
>contractions) is adjustable, has a short half life (so it goes away
>quickly if you need it to), and most importantly, gets the job done.
>
>Why do you need an induction? Maybe you will go into labor on your own.
>That is the best way of all.
>
>--
>William D. McIntosh, MD
>Clarksville, TN
>
>This is for educational purposes only. It is not intended
> to replace consultation and examination by your physician
> or other health care provider.

Like or dislike is not the issue:) You gave me the kind of answer/opinion I was looking for. There is always the possibilty that I will go into labor on my own but my track record isn't terribly good. A quick hx-1st baby-induced at AT LEAST 42w1d-LMP and U/S were weeks apart-OB went by later date. Induced with pit-cervix 1-2cm and 20%-AROM and nothing came out-baby distressed shortly after AROM-and C-section was performed-delivered healthy 7#12oz girl. Offically dx with oligohydramnios. #2 baby induced at 39weeks with pit after U/S diagnosed oligohydramnios-only had 6 pockets-cervix was less than a 1cm and 20%-delivered 7#boy 13 hours later-baby was dehydrated at birth but otherwise OK. #3 baby induced at 41w2d with Cervidil alone-fluid was low but within acceptable limits-felt it was better to get the baby out while he was doing well and I still had decent fluid levels. 7#14oz boy. Obviously my midwife and I are rooting for a spontaneous labor (I'll start taking EPO at 36 weeks) but we still are making plans just in case. FWIW, my mother only went into spontaneous labor once and that was at 45 weeks. Who knows, maybe there is some strange hereditary factor at work here?? Will keep y'all up to date on what happens. Thanks a lot for the comment, it makes sense and really answered some nagging questions I had.

karen



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