At once place I work, we nurses place the cytotec in the cervical fornix......upon receiving orders from the dr. --- usually 25 mcg (1/4 pill).
At the other hospital, we give it ORALLY ONLY...never placing it in the vagina. For obvious reasons, patients prefer this.
Both ways, the drug seems to act in the same UNPREDICTABLE WAY. It either does what we want it to, does nothing, or does TOO DARN MUCH....who can say what you will get? I find this unsettling to say the least. NO, at NEITHER PLACE, have we used Bishop's Scoring for a VERY LONG TIME....some nurses don't even know what that involves! REALLY!
We must remember, cytotec is STILL NOT approved for labor induction use by the FDA...this is what concerns so many nurses. That, and it has been linked to quite a few cases of hypertonus and even uterine rupture. Once that little pill is absorbed, little control remains over how it acts on the patient's uterus. I keep Brethine *on my person* when administering cytotec....but this is still small comfort to me. I personally prefer not messing w/cytotec inductions. The more I read out there, the more I feel we are playing w/fire, esp. w/o approval of this drug for labor induction/cervical ripening. I would prefer sticking to cervidil, at least you can PULL IT OUT......
Anyhow, those are my thoughts on this, Mark. There are some VERY good threads in the Perinatal Listserves about this subject, mostly to the negative, regarding the use of cytotec. Some hospitals/doctors have ceased using it altogether. Too risky they say. I can't say I disagree. It usually takes something tragic or drastic, though, to get them to change their minds! Scary indeed.