Re: Pitocin and an unripe cervix
From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Mon, 22 Nov 1999 21:20:45 -0600 (CST)
At Mon, 22 Nov 1999, Olivia wrote:
>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
Severely limited by the information provided (you did a great job but
that's why they have fetal heart tracings and these big charts) it
sounds at first blush that the hosital may have been correct with "the
cause of the problem was
parity and hyperstimulation of my uterus caused by the Prostin gel"
causing a precipitous labor. Some people feel high parity is a relative
(not absolute) contraindication to induction. Some of the literature
seems to indicate that when regular contractions are achieved, pitocin
is the next step.
--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York
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