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Re: Pitocin and an unripe cervixFrom: Olivia (anonymous@obgyn.net)Mon, 22 Nov 1999 00:15:14 -0600 (CST)
At Sun, 21 Nov 1999, Harvey S. Marchbein, M.D. wrote: > >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 Dear Doctor Marchbein My fifth baby was born 15 months ago and suffered significant asphyxia at birth which has left her with developmental delays. I read your answer to the doula about the use of prostin gel when there are contractions and would value your opinion on my labour. It took place in NZ. I was induced at 41+ weeks because of a large baby, malpresentation and liquor volume diminishing. I had had a previous Deep Tranverse Arrest labour and my last labour was rapid going from 5cm dilatation to delivery in 35 minutes. The prostin gel was administered on the morning of my babys birth and my cervix at that stage was 1/2 effaced thick os 1cm. There was immediate response with tightenings 2-3 in 10 minutes. During the day the contractions increased in both frequency and intensity until eight hours after the first dose of prostin gel my VE showed CX external os admits finger tip, internal os closed 50% closed. The second dose of gel was administered and the contractions immediately became stronger. Within 2 hours my baby was born with the cord around her neck and with apgars of 2,4,5 and 8. She was intubated immediately and extubated 21 minutes later. She took seizures at 4 hours of age and was flown to a large centre. The seizures stopped t 2 days of age and she has been well since except for low muscle tone and developmental delays. The hospital report states that the cause of the problem was parity and hyperstimulation of my uterus caused by the Prostin gel. Sorry to be so long winded but after reading what you wrote about the administration of prostin gel when contractions are occurring was startling and I would value your opinion on my management. Many thanks Olivia>>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 >and, as such, do not constitute a physician-patient relationship. >This information is not intended to supplant the need for you to >consult with your physician prior to choosing therapeutic options >and/or interventions. > >**Private emails cannot be entertained due to time constraints, >consequently no private emails will receive a response. > >**Thank you for your understanding ;-) >
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