Comments on: Misoprostol for post partum hemmorhage? meh.

By: Dr. S. Lee

Dr. S. Lee — Thu, 11 Sep 2008 19:09:40 +0000

Maybe 8 hours of pitocin caused the hemorrhage. It is meant to be used a maximum of 4 hours at a time. Hemorrhaging is a known side effect of overuse.

By: Brad Armstrong

Brad Armstrong — Sat, 23 Aug 2008 01:32:47 +0000

P.S I am from Brisbane, Australia

By: Brad Armstrong

Brad Armstrong — Sat, 23 Aug 2008 01:31:28 +0000

Hi Nick,

We use PR misoprostol routinely in the treatment of postpartum haemorhage.

I completely accept your points ….

PR administration is the same as giving it via any other mucous membrane – I suppose giving it PR means that nothing is taken orally should the patient deteriorate and require intubation in theatre.

It takes 30 mins or so to have an effect – syntocinon and ergometrine remain the first line treatment for PPH with misoprostol giving that extra long lasting “crunch” to stop uterine bleeding.

Love your podcasts – keep them up. I’m encouraging my registrars to download them. Cheers,

Brad Armstrong

By: Nick Fogelson

Nick Fogelson — Thu, 13 Dec 2007 01:51:11 +0000

Hmm. 5-10 cases that didn’t already get hemabate or methergine? I use miso all the time before abortion procedures and it takes at least 30 minutes to have an appreciable effect on the cervix and uterus.

Maybe it works better in the South Chris! PS you are going to cohost this podcast with me next year. At least two episodes a month.

By: Christopher Robinson, MD

Christopher Robinson, MD — Thu, 13 Dec 2007 01:35:45 +0000

P.S. When is the next podcast? Keep them coming, I really enjoyed the last one on DaVinci.

Chris

By: Christopher Robinson, MD

Christopher Robinson, MD — Thu, 13 Dec 2007 01:35:00 +0000

Nick,
I guess we can agree to disagree on this. I agree that your logic seems to make a lot of sense. However, I have also seen a number of patients (5-10) that responded well to rectal or buccal mispostol. It is true that the rectum is not a special place for it. It can just as easily work in the mouth. It has been compared to IV pitocin in prophlaxis of postpartum hemorrhage. In that study, there was no difference in the amount of blood loss between the two groups. There was also no difference in the number of patients experiencing a postpartum hemorrhage. I must say that I think it still belongs in our options. Of note, I use 1000mcg rectally but some studies have used lower doses.

As for oxytocin receptors, they are downregulated by about 4 hours when on pitocin drip. There is good evidence that the downregulation of these receptors is accompanied by an upregulation of prostaglandin receptors. Thus, use of a prostin would make more sense in controlling pp hemorrhage when the patient has been overexposed to pitocin. I published this in AJOG a few years back.

I hope you and Wendy are doing well and we are all looking forward to seeing you both back in Charleston next year!