WOMENS-HEALTH Messages for September, 2000: Re: The truth about Cytotec...

Re: The truth about Cytotec...

From: anonymous@obgyn.net
Sun, 3 Sep 2000 10:17:21 -0500 (CDT)

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Reply: William F. von Almen, II, MD, FACOG: "Re: The truth about Cytotec..."
Reply: William F. von Almen, II, MD, FACOG: "Re: Dr Almen - reply"

I wanted to add the abstracts from this particular study here as well. This drug is being used by many physicians for inductions, including women with prior cesarean(s) and/or other uterine scarring. Perhaps you are more prudent as to do this (many physicians are not), but how can you equate a rupture rate 28 times higher with that of eating a Big Mac? I'm not trying to debate, but I also know the informed consent is often skewed to give the least possible risks given for whatever a physician wants a patient to consent to and the most possible risks of what they do not want a patient to consent to. I respect your training and knowledge, but unfortunately have found that we all need to learn further as women how to be informed consumers.

Plaut M, Schwartz M, Lubarsky S "Uterine rupture associated with the use of soprostol in the gravid patient with a previous cesarean section" Am J Obstet Gynecol vol 180, number 6, part 1, 1535-1542 June 1999

Objective: Our purpose is to report our experience with uterine rupture in patients undergoing a trial of labor after previous cesarean delivery in which labor was induced with misoprostol. The literature on the use of misoprostol in the setting of previous cesarean section is reviewed. Study Design: This report was based on case reports, a computerized search of medical records, and literature review. Results: Uterine rupture occurred in 5 of 89 patients with previous cesarean delivery who had labor induced with misoprostol. The uterine rupture rate for patients attempting vaginal birth after cesarean section was significantly higher in those who received misoprostol, 5.6%, than in those who did not, 0.2% (1/423, P = .0001). Review of the literature reveals insufficient data to support the use of misoprostol in the patient with a previous cesarean delivery. Conclusion: Misoprostol may increase the risk of uterine rupture in the patient with a scarred uterus. Carefully controlled studies of the risks and benefits of misoprostol are necessary before its widespread use in this setting. (Am J Obstet Gynecol 1999;180:1535-42.)

At Sat, 2 Sep 2000, Kelly Shanahan, MD wrote: >

>Anything used improperly has the potential for harm -- too many Big Macs
>can make you fat and contribute to high blood pressure and you can have
>a heart attack and die. Half the things we use in medicine (especially
>in ob) are off albel uses.
>
>Cytotec has a place in hte induction of labor -- and it has great
>potential for misuse. Informed consent should be given, and your doctor
>must be aware of hte potential benefits and risks and the literature to
>support this -- and inform you of it.
>
>Properlyy selected patients receiving Cytotec in the proper dose, with
>the proper monitoring do very well for hte most part. Yes uterine
>rupture may happen, but it can happen in spontaneously occuring labor as
>well.
>
>Ask questions. Get all the info youu need to make a decision. But
>don't throw the baby out with the bathwater.
>
>--
>M. Kelly Shanahan, MD, FACOG
>South Lake Tahoe, CA
>
>This information is for educational purposes only and does not construe a doctor-patient relationship. It does not replace the need for you to consult your own doctor.
>
>***private e-mails will be deleted without reading. Please respect my family time
>

Next message: anonymous@obgyn.net: "Re: Dr Almen - reply"
Previous message: Peggy: "Re: Dr Marchbein-Peggy(Dr.von Almen)"
In reply to: Kelly Shanahan, MD: "Re: The truth about Cytotec..."
Next in thread: William F. von Almen, II, MD, FACOG: "Re: The truth about Cytotec..."
Reply: William F. von Almen, II, MD, FACOG: "Re: The truth about Cytotec..."
Reply: William F. von Almen, II, MD, FACOG: "Re: Dr Almen - reply"

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