Are they still using Cytotec?

SmilingBluEyes · Jul 15, 2005

It's been approved via the "loop hole" you suggest and yes we ARE still using it. All the time.

It's much the same as using Brethine to stop PTL or Magnesium Sulfate to lower blood pressure. Off-market use of drugs is something that is done all the time. Not to say complacency is appropriate because obviously it's not. But yes, Cytotec is used by many practioners for cervical ripening.

dixienurse2be · Jul 15, 2005

yep saw it just yesterday during clinicals

RNnL&D · Jul 15, 2005

It's been approved via the "loop hole" you suggest and yes we ARE still using it. All the time.
It's much the same as using Brethine to stop PTL or Magnesium Sulfate to lower blood pressure. Off-market use of drugs is something that is done all the time. Not to say complacency is appropriate because obviously it's not. But yes, Cytotec is used by many practioners for cervical ripening.

Every place I know is still using it.

FrumDoula · Jul 15, 2005

Cytotec scares the cr*p out of me. It's much less manageable, it seems, than some of the other cervical ripening agents, and therefore less safe. I've heard that women are often not told about its possible side effects, and the fact that it's being used off label.

On another board that I frequent, someone said their homebirth midwife (CNM) wanted to use to help induce labor on a postdates woman. I was absolutely SHOCKED. I thought that with Cytotec, there was specific monitoring protocol, like with Pit or any other chemical intervention, to make sure you're not hyperstiming a woman or causing a rupture. And ruptures have happened frequently enough with Cytotec that I would be wary to use it without some serious monitoring.

Can the L&D RN's here tell me what their monitoring protocol is for Cytotec?

Alison

BENNETTRN · Jul 15, 2005

Dose your L&D ward still use Cytotec? Do you know if Cytotec was ever banned from being used in L&D? I know it was not approved by the FDA to be used in labor but doctors found "loop holes"

We use it for DIU's only at our hospital.

PegRNBSN · Jul 15, 2005

Our hospital is one of the last in our city to hold out on using cytotec. The scoop on cytotec is that when it was first tried and studied high doses were used. It came out being much more effective than cervidil and much less expensive. However this is also where you saw the adverse outcomes due to hyperstim.

When cytotec was then used in smaller doses the adverse outcomes went way down but so did effectiveness. It is no more effective than cervidil which is much easier to control (you take it out) than cytotec. All that remains is cost effectiveness (a few dollars for cytotec vs. $150 for cervidil).

However, if I were a patient or MD I would certainly think it was worth the money to use a safer drug that is specifically authorized for cervical ripening.

SmilingBluEyes · Jul 15, 2005

Cytotec scares the cr*p out of me. It's much less manageable, it seems, than some of the other cervical ripening agents, and therefore less safe. I've heard that women are often not told about its possible side effects, and the fact that it's being used off label.
On another board that I frequent, someone said their homebirth midwife (CNM) wanted to use to help induce labor on a postdates woman. I was absolutely SHOCKED. I thought that with Cytotec, there was specific monitoring protocol, like with Pit or any other chemical intervention, to make sure you're not hyperstiming a woman or causing a rupture. And ruptures have happened frequently enough with Cytotec that I would be wary to use it without some serious monitoring.
Can the L&D RN's here tell me what their monitoring protocol is for Cytotec?
Alison

The woman being ripened with cytotec is admitted to the hospital. A 20-30 minute strip is run to ensure reassuring heart tones. Then after placement, the mom remains on the monitor for 1-2 hours afterward as a minimum to ensure all is ok. Usually, if contracting at all afterward, the mom is kept on the monitor to see how the fetus is tolerating this. This medication is very unpredictible. It either works or not. It will either work very well ( or too well) or just do nothing. I dont' like the unpredictibility of this drug, either. I have seen women go into full-blown labor after use, others it did not make one bit of difference. I keep Brethine (terbutaline) in my pocket and handy in case the contractions hit too fast and hard and need to be slowed down.

One must respect any drug or herb used for labor induction or cervical ripening-----all can be unpredictible and need intervention at some point or another.

I have noticed the same results whether the drug is administered orally or lady partslly.

It makes a great postpartum hemorrhage treatment----I have seen it stop hemorrhages COLD when used rectally. Like pitocin, it's almost a "different drug" when used postpartum!

KaroSnowQueen, RN · Jul 15, 2005

My DD was given Cytotec 2.5 mg orally q4h x4 prior to being given Pit to induce her labor. This was one month ago. Do places still use it lady partslly?

RNnL&D · Jul 15, 2005

My DD was given Cytotec 2.5 mg orally q4h x4 prior to being given Pit to induce her labor. This was one month ago. Do places still use it lady partslly?

Yep, we use it lady partslly. 25 mcg q 4 hours. Many of the docs prefer Cervidil, but the ones who use Cytotec seem to prefer it because it's cheaper, requires less monitoring (2 hours post, compared to continuous for Cervidil), can be used after SROM, and doesn't require a wait before using Pitocin (Pit isn't started until 4 hrs after dc'ing Cervidil).

We use it pretty conservatively. I have had one hyperstim, where I had to use Brethine with Cytotec in the 2 1/2 years I have been at this hospital. I have actually seen hyperstim more often with Cervidil, and yes it can be pulled. But it seems like you still end up with a precipitous delivery. Of course, that's just my experience.

OBRN2004 · Jul 16, 2005

We still use cytotec to induce labors, pp hem, etc. The MD must be the one to administer this drug, Our orders are usually 25 mcg vag q4 x4 doses. They have given po before, but usually only on the IUFD and usually a higher dosage. We also have used it rectally for pp hems. We do require 4 hours to pass after the last dose before starting Pitocin. I it is very unpredictable, though. You never know who it's going to work on. I had two cytotec inductions this week, both term, both severe pre-ecl. One changed from ft/th/high to 3/50 after 1 dose, where the other one after 4 doses was 1-2 cm (and that was being awfully generous!). You just never know!

jkaee · Jul 17, 2005

It makes a great postpartum hemorrhage treatment----I have seen it stop hemorrhages COLD when used rectally. Like pitocin, it's almost a "different drug" when used postpartum!

My sister just had a PP hemorrhage and she was telling me that they "put a pill up her butt". I had NO idea what she was talking about. Her nurse did say that the Cytotec rectally was the last resort before they had to manually "scrape" her uterus to check for placental fragments. But, the Cytotec did work and the bleeding greatly diminished.

Wow, you learn something new every day!