Date: Tue, 30 May 2000 10:45:36 -0500


Reply-To: ob-gyn-l@obgyn.net
Originator: ob-gyn-l
Sender: ob-gyn-l@obgyn.net
From: sanbonav@tin.it
To: Multiple recipients of list OB-GYN-L
Subject: Re: new case;labor is also a uterine muscolar work
X-Comment: Obstetrics & Gynecology for Medical Professionals ONLY

>reading all responses to this case I am quite surprised to see
>that nobody remembers that labor is also a uterine muscolar work
>So as You prepare yourself  before  running drinking salts and energetic
>substancies to avoid cramps in legs during footing , You have to prepare
>uterus (to avoid irregular contractions that means cramps,pain for mother,
>stress for fetus and inefficient uterine dilatation)by administrating fluids
>before labor induction or at the beginning of labor
>In my Department I suggested  fluid-loading therapy :the administration of
> 250 cc of glucose-6-Phosphate solution and 500cc of
>Darrow(elettrolitical) solution intravenously
> before induction to avoid uterine ipertonus or at the beginning of
>spontaneous labor
>to have regular no-distressing uterine contractions.
>electrolite dosage before therapy is unuseful ,time and money consuming.
>My midwifes are very satisfied about the results ,and now they do it with
>every woman in labor
>Hope this helps
>Yours faithfully
>Emilio Porro M.D.
>
 

>At Mon, 29 May 2000, Betsy Hyde wrote:
>>
>>At 10:17 AM 5/29/00, Luis Sanchez-Ramos, MD wrote:
>>
>>>It is hard for me to believe that a patient with an unscarred uterus
>>>would suffer a catastrophic uterine rupture with two separate 25 mcg
>>>doses of misoprostol (adminestered to apatient who is not having regular
>>>uterine activity).
>>
>>these are the facts. The woman received 2 25 mcg doses of misoprostil, 4-6
>>hours apart. Our institutional protocols state that doses will not be
>>repeated if contractions are more frequent q 3-4 minutes.  The second dose
>>was given only because she was *not* contracting. After the second dose she
>>had a brief period of very painful contractions, and developed tachycardia.
>>The contractions then stopped. Not detectable on the monitor and not
>>reported by the woman.
>>
>>The purpose of my post was to elicit the opinions of list
>>members in nailing down a reason for tachycardia, SOB and abdominal pain in
>>a woman who had delivered a stillborn fetus. At the time of my post,
>>neither I nor my OB attending, cardiologist, MFM consult, or general
>>surgeon knew she'd sustained a uterine rupture. The diagnosis was made at
>>surgery, well after I posted this case. Although uterine rupture was
>>include in my list of differentials (along w/ PE and AFE), there was no way
>>to confirm the diagnosis.
>>
>>I posted this case because it was a puzzle. I don't think I deserved the
>>comments that we shouldn't ever use miso because we don't know how to use
>>it, that we are "eager to make public these occurrences", and that I am, in
>>some way attempting to hide other examples of uterine rupture in my
>>practice.  I am not.
>>
>>It is certainly disappointing that a straight-forward posting of an
>>interesting (to me) clinical case is met by such hostile replies by someone
>>with such a wealth of experience in the area of misoprostil use.
>>
>>--
>>Betsy Hyde CNM
>>Assistant Clinical Professor, Yale University
>>Director, Midwifery Services
>>Obstetrics-Gynecology-Infertility Group, PC
>>New Haven, CT
>>
>
Porro Emilio
Ob-Gyn.M.D.
Via Zezio 69
22100 COMO (Alessandro Volta City)
ITALY
phone:031/30 21 46
e-mail:
sanbonav@tin.it
sanbonav@hotmail.com
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