[rtoi123]

I was watching the news when I should have been studying and they did a story on a Rockdale county woman who is suing her OB/GYN for using Cytotec to induce her labor because the baby was born stillborn and he had not told her that the medication was not FDA approved. I have always known that it wasn't FDA approved for pregnancy because it can induce labor but I thought it was an approved off-label use to induce full-term pregnant women. The news said that it was not approved for this use and the risks are death to the patient or the fetus during labor. I was wondering how many of you guys use Cytotec as an inducing agent? And if you use Cytotec do you tell them that the drug is not FDA approved? I know where I work we have always used it and one of the practices I am doing clinicals at gives it P.O. and the patient just gets it filled at the drug store and comes in the next AM. How do you guys feel about these practices and do you think the low cost of Cytotec is why they are using this drug? The news really did a number on this doctor and the Rockdale hospital.
I should go study, but I can't stop thinking about this issue..
Rachel

[k_cole21]

Being a traveler I've worked at 8 facilities, all but one have used cytotec for induction of labor. The other hospital only used it for fetal demises. Over the last year I've seen it given more & more PO. I like the uterine pattern better with PO than vag. However, the facility I'm at now they give 50 mcg instead of 25mcg which I'm not comfortable with (the physician actually have to place the larger dose). One hospital I worked at gave it vag, monitored for 1 hour, sent them home, the came back in 4 hours for another dose. It takes about an hour to kick in so that was pointless. I don't mind it if the pt is continuously monitored but I think it's dangerous to send those pts home or have them fill the script and then come in. That's very careless since this is not an FDA approved drug for induction. I've seen cytotec take a toll on babies b/c of hyperstimulation.

[rninwch]

We use it at our facility. All patients must sign a special consent that actually states that it is not FDA approved. The consent also lists the risks/benefits.

We give 50-100mcg PO q 4h. Monitor them continuously for 1-2 hours then let them walk with pattern checks q50min x10min. We only send the pt home IF it has been >4 hrs since the last dose AND they have reassuring FHR and no contractions. Pit can only be used if 4 hrs have passed since the last dose.

I hate inductions, I know we use high doses, but (knock on wood) I have yet to see any emergencies. I have seen some hyperstim, but it responded well to terb and fluids. Of course we don't use cytotec on previous sections, multiples or grand multips.

[k_cole21]

100 mcg? That's overkill unless it's a FD! I'd question that policy/procedure. That's an aweful lot and sounds very unsafe. It's one thing to have them sign a consent saying it's not FDA approved, but the dosage should be "safe" and I think 100 mcg is unsafe. Those that use 50 mcg even do it q 6 hours (25 mcg q 4). It just seems they should be a little more cautious since it is such a "dangerous" med. It sounds like your docs want to blast those kids out!

[May_baby]

Wikipedia Page on Cytotec (Misoprostol):
http://en.wikipedia.org/wiki/Misoprostol

FDA Handout for Health Professionals:
http://www.fda.gov/cder/foi/label/2002/19268slr037.pdf

FDA Handout for Patients:
http://www.fda.gov/cder/drug/InfoShe...prostolPIS.pdf

Sealre (Pfizer) August 2000 letter to Health Care Providers:
http://www.fda.gov/medwatch/safety/2000/cytote.htm

[Elvish]

We use it to induce labor on known FDs but there is a cutoff (20 weeks gestation, I think). We also use it PR for PP hemorrhages sometimes. I personally don't like it.

[mitchsmom]

I'm an RN; we use it all the time on our unit. I asked why we never use cervidil and I was told it was too expensive.

We use 25mcg vaginally; I've only seen more used for demises. We monitor for 2 hours after administration, intermittent may be used after that if monitoring has been reassuring & no hyperstim. But pts are still on bedrest with bathroom privilages. We never give it and send home.