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

Re: The truth about Cytotec...

From: William F. von Almen, II, MD, FACOG (anonymous@obgyn.net)
Sun, 3 Sep 2000 16:26:08 -0500 (CDT)

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At Sun, 3 Sep 2000, anonymous@obgyn.net wrote: >
>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
>>

I think most ob's are beginning to question the value of misoprostol with a previous C/S. I personally will not use it, as I have seen several ruptures, personally. Hope this helps.

--
William F. von Almen, II, MD, FACOG
Editorial Advisor-Pregnancy and Birth
Private Practice
New Orleans, La.

*Please understand I can not respond to private emails.

*These comments are for educational purposes only.  They are
not meant to take the place of an examination by a qualified
health care provider.  They are not intended to be the start
of a physician-patient relationship.

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

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