Cervidil and uterine rupture

gladtobeOB · Aug 4, 2004

First off what is this board that you are looking at, I would like to visit it since I am new to ob. What a horrible thing to happen with your first child. I did read somewhere on the net about a woman that was being induced with cerividil or cytotec and they had a policy of so many hours(cant remember) before starting pitocin. Well it turned out to be only 10 minutes from their documentation. In the end of that case the woman's uterus had ruputured, massive bleeding and baby died....Where I work they use prostin gel.... Asked one of the midwives why they don't use cytotec and they said that cytotec has been known to cause more problems than the prositn??????

lady_jezebel · Aug 4, 2004

First off what is this board that you are looking at, I would like to visit it since I am new to ob. What a horrible thing to happen with your first child. I did read somewhere on the net about a woman that was being induced with cerividil or cytotec and they had a policy of so many hours(cant remember) before starting pitocin. Well it turned out to be only 10 minutes from their documentation. In the end of that case the woman's uterus had ruputured, massive bleeding and baby died....Where I work they use prostin gel.... Asked one of the midwives why they don't use cytotec and they said that cytotec has been known to cause more problems than the prositn??????

Unlike Cytotec (which is very controversial & NOT approved for OB purposes), Cervidil is approved for labor induction. It is a prostaglandin. It is commonly used without major adverse events, I believe. However, I've read that there is a risk of uterine rupture with Cervidil for VBACs, or when pitocin is co-administered. In this case (below), it was her 1st pregnancy & oxytocin was not given. The forum was:

http://www.pregnancylounge.com

The woman posted in 3rd trimester & here's a copy of what the author described:

" I went to the hospital at midnight on Thursday night to check the position of the baby because my doctor thought he might have turned breech on me. Turns out that he was still head down. The doctor decided to put some Cervidil down there to see if we could get labor going. Everything went fine with that for about 3 hours. At somewhere around 3:30 I started to get really bad cramps which felt like contractions, but weren't registering on the monitor. I felt a gush of fluid which I thought was my water breaking, so I called the nurse in. She checked me and instead of it being fluid, I was bleeding pretty bad. My doctor came in and checked me, and the next thing I knew I was being taken off for an emergency c-section.

Aparently my placenta tore pretty badly, and they're not sure why. They assured me it was nothign to do with the cervidil, and that nothing I did could have caused this. Had I not gone into the hospital that night for the induction, the baby and I probably wouldn't have made it. I lost soo much blood so quickly. The last thing I remember is being wheeled into the OR for the surgery and the one male nurse telling me everything would be fine, and before I knew it, I would be awake and with my baby. He was awesome.

Unfortunately I don't remember much about the c-section, only what the doctor tells us. My boyfriend wasn't allowed to be there for it, and he cried for nearly an hour until he found out I was OK.

I woke up around 7:30, but didn't get to see Austin until close to 10:00.

Recovery wasn't too bad. They gave me a lot of blood and fluids for the first day. My red cell count dropped down to 7.7 which is bad I guess? I was up and walking around Saturday, but I would have on Friday if they didn't still insist on me having a catheter in. As soon as I got the chance, I got my butt out of bed to make myself feel better. I wasn't even supposed to be released from the hospital until Monday morning, but since I was doing so well, and baby Austin was doing great, they let me come home today after they found out my blood count came back up to normal."

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Please, anyone here have experience with Cervidil??

lady_jezebel · Aug 4, 2004

bringing this back to the top, in case anyone k...

SmilingBluEyes · Aug 4, 2004

First off, Uterine rupture can occur in ANYONE at a frequency rate of 0.1-1%, depending on a lot of variables. There are not nearly enough specifics in this story to tell me exactly why this happened to this person. Yes, when inducing labor with ANYTHING, whether it be cervidil, cytotec, prostin or pitocin, it is very important for OB nurses to keep track of fetal heart tones and contraction strength and frequency.

It's important to note: Where I work we NEVER use cytotec, prostin or cervidil in TOLAC (trial of labor after csection/VBAC), for this reason. A person who has had a prior csection has an increased risk of rupture at 1-5%, over the average 0.1% for NON-prior csection. Cervical ripening agents are risky in that no one can turn them off, unlike pitocin, and they can have long half-lives, making it hard to stop hyperstimulation of the uterus if it should happen, even with the use of Brethine.

This may just be me, but I would want a few more facts before making many judgement calls in this case. It could be a rare cataclysmic and unfortunate occurence for this patient unrelated to cervidil. I just don't know. Uterine rupture is rare but a true emergency and every Labor and Deliver nurse MUST be aware of the signs and be ready to intervene rapidly if it happens to his/her patient.

lady_jezebel · Aug 4, 2004

To me it seemed like a direct cause-and-effect event, but that's probably b/c I know almost nothing about OB! Ok, thanks -- obviously I made an incorrect assumption here.

The thing that bothered me about her story is that the docs reassured her that all of this had nothing to do with the Cervidil. Is it possible for them to rule that out so quickly? Doesn't the risk of uterine rupture increase with any inductive drug? I was just wondering how honest they were with her. She's under the impression that all of this could have happened at home, even though she had an uneventful pregnancy -- she was just a little overdue.

SmilingBluEyes · Aug 4, 2004

make no assumptions. this is a story where we don't have all the facts. I realize you are expecting this fall. I urge you to be careful reading horror stories online about labor and delivery. It won't do much for your education but WILL stress you out. That you don't need. I wish you the best!

lady_jezebel · Aug 4, 2004

Isn't there an increased risk of uterine rupture with Cervidil ABOVE the baseline risk? Are pts informed of all possible side-effects & potential adverse events before its application? Do pts sign a consent form?....

SmilingBluEyes · Aug 4, 2004

Yes consents are signed, where I am working. Risks are discussed prior to the patient signing anything. Please understand, I am not going to get into all the nitty gritty stats here with you, however. You are asking as an OB patient . I don't want to cross a line here.

I think it would be inappropriate for me (or anyone here who is not your health care provider) to advise you on this given your pregnancy and personal situation. I know your concerns and and respect them. I must caution you to seek the information you need from your health care provider, not an internet board. Do this especially if you are concerned about their using cervical ripening agents on you---- and to advise you of all the latest facts BEFORE you sign anything. I wish you well! Hopefully, your concerns can be laid to rest by having a nice talk with your midwife or OB care provider. :)

lady_jezebel · Aug 4, 2004

Smiling, thanks for your info. I'm not trying to inform myself of this b/c I am considering being induced, or "as an OB pt". I'm just interested in OB issues b/c I'm a nurse, and now pregnant. I'm dissatisfied with my current area (med-surg), and though OB never interested me in school, this pregnancy has made me take notice of a new field. I've been trying to inform myself for personal reasons AND b/c it's important for nurses to have info about anything medical, in my opinion.

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Anyone else know if Cervidil can increase the risk of uterine rupture? Anyone seen an actual case of this, or is it rare?

SmilingBluEyes · Aug 4, 2004

I can understand what you are saying and respect it. But you can see my position, here, too. I consider myself talking to an obstetric patient as well as fellow nurse. I can reassure you ,where I work, we are extremely cautious using ANY cervical ripening or labor-inducing agents. We monitor mom and baby very closely to observe for complications of any sort early-on and are trained well to intervene in the rare case that something goes wrong. Also, I am careful what I discuss as I can only say so much, and try not to cross lines to gray areas.

As for a switch in your career, with med-surge behind you, you would be so welcomed into OB . I don't blame you for wishing to educate yourself, either. I would, too. I just think we can't be too careful from where we derive our information/research. I can provide a lot of anecdotal information based on my practice in OB nursing over 7 years. I can also point you to places to get the information. I think my anecdotal information is not what you need or are looking for in your case. But there is a lot of info from AWHONN and other Obstetric organizations/sites from which you can obtain reliable and well-researched information.

I hope you find what you need, and again, if you choose to enter OB nursing, I for one, welcome you warmly. Hope the rest of your pregnancy is healthy and uneventful, as will be your delivery in November! Hugs.

lady_jezebel · Aug 4, 2004

I can understand what you are saying and respect it. But you can see my position, here, too. I consider myself talking to an obstetric patient as well as fellow nurse. I can reassure you ,where I work, we are extremely cautious using ANY cervical ripening or labor-inducing agents. We monitor mom and baby very closely to observe for complications of any sort early-on and are trained well to intervene in the rare case that something goes wrong. Also, I am careful what I discuss as I can only say so much, and try not to cross lines to gray areas.
As for a switch in your career, with med-surge behind you, you would be so welcomed into OB . I don't blame you for wishing to educate yourself, either. I would, too. I just think we can't be too careful from where we derive our information/research. I can provide a lot of anecdotal information based on my practice in OB nursing over 7 years. I can also point you to places to get the information. I think my anecdotal information is not what you need or are looking for in your case. But there is a lot of info from AWHONN and other Obstetric organizations/sites from which you can obtain reliable and well-researched information.
I hope you find what you need, and again, if you choose to enter OB nursing, I for one, welcome you warmly. Hope the rest of your pregnancy is healthy and uneventful, as will be your delivery in November! Hugs.

OK. Thanks for the info. I'll pursue the AWHONN and other obstetrics sites for stats. :)