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Re: Pitocin and an unripe cervix

From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Sun, 21 Nov 1999 22:45:02 -0600 (CST)

At Sun, 21 Nov 1999, heather wrote: >
>I am a doula and this is what happened at a recent birth. The womans
>water broke at 40 weeks +2 days so she went to the hospital to confirm
>that it was amniotic fluid. it was and they admitted her, although she
>was not feeling contractions(they were registering on the EFM regularly)
>and her cervix was closed and not effaced. She was immediately was put
>on Pitocin and 20 hours later was only a fingertip and maybe 60%
>effaced. Of course she had a c-sec. My questions are: could a
>prostaglandin gel be used even though her water broke?

PG can be used in such a situation but the hospital protocol may not allow it if there were regular contractions. The use of Prostaglandin gel while noting regular contractions has been associated with hyperstimulation of the uterus, which can lead to problems with the baby as well as a ruptured uterus.

>i think i have
>seen info that it can. Pitocin doesnt ripen the cervix, correct?

It can, depending upon the person and the aforementioned Bishop's score.

>The
>risk of infection increases with manual exams. The doctor examined her
>several times. I dont think this birth was managed very well by the
>medical staff. please help me understand what happened.
>

By ACOG criteria, antibiotics to reduce the chance of infection are recommended after 18 hours of ruptured membranes (one of several reasons antibiotics are used). Exams should be kept to a minimum but exams need to be done when evaluation is necessary. It would be impossible to comment on any particular labor management.

>--
>doula
>

--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York


**Note:  Opinions expressed here are for educational purposes only
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This information is not intended to supplant the need for you to
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