cytotec

  1. one more question for tonight. do nurses at your facility place cytotec for inductions when ordered vaginally? we do and a few of the nurses are refusing to do it.

    but to me that is crazy since they are willing to give it PO. to me I don't see much more risk?

    also do you do the BISHOPS score before giving each PO does as you would for the vaginal dose. I do , and think it should be. but we are having some debate here also. thanks
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  2. 14 Comments

  3. by   SmilingBluEyes
    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.
  4. by   Jolie
    Mark,

    I can't give you any advice specific to Cytotec, since I quit working in OB before it was used, but, as with any new medication or procedure in OB, I would strictly warn you against administering it without a specific written policy and procedure.

    As you know, Cytotec is not a completely harmless drug. It can and does have serious side effects, and it is not FDA approved for OB use. Of course that does not mean that it can't be safely used for OB patients, but it does mean that extreme caution is warranted, including informed consent on the part of the patient. Ask your manager to develop a P&P to cover you for administering this drug, including expectations for assessing the patient, such as a Bishop's Score, and indications for with-holding doses.

    In the meantime, I would insist on specific written orders from the OB each time Cytotec is ordered. You don't want to be answering to a lawyer on this.
  5. by   SmilingBluEyes
    We have a specific policy/procedure, including contraindications both places I work.....Still the use of Cytotec in labor unsettles me so. I don't think we have finished w/the controversy regarding its use and hazards. I REALLY recommend interested parties wanting more info "from the trenches" access the Perinatal Listserve Archives (Univ of Buffalo, NY). There is much wisdom/experience out there, some of it will enlighten or even unnerve you!
    Last edit by SmilingBluEyes on Nov 7, '02
  6. by   anitame
    We only give Cytotec per vagina. The docs here indicate it's "unpredictable" when given PO. This is amusing to me because, as Debbie said, it's unpredictable ANYWAY. We have a very specific P & P regarding Cytotec use. Not to be used for VBAC (actually any hx of uterine surgery), multiple gestation, non vertex presentation, etc, etc.
    Our policy is to do a Bishop's score prior to every dose. If the score is < 7 RN may insert IF there are no more than 3 u/c q 10 min. Sometimes the provider will come in and give the Cytotec with a Bishop of 7 or 8 or with more than 3 u/c q 10 min if the pt is not feeling them.
    Debbie, I agree. I'm on the perinatal listserve too. Cytotec inductions keep me on edge the entire shift. And I HATE HATE HATE when the stuff makes my perfectly normal nice patient all the sudden psycho cause she's going from 1cm to complete in an hour or two I am MUCH more comfortable with a Pitocin induction after Cervidil.
    Anita
  7. by   rdhdnrs
    We as nurses don't place cytotec at all; a physician has to give it.
  8. by   OBNurseShelley
    We never give cytotec PO, and we occasionally use it vaginally and nurses do place it, tho very few physicians use it, except in the case of an early demise, which it can work well than. We don't use cervidil either because of the cost, we use prostin gel quite frequently for ripening or low dose pitocin the full pit induction, I think cytotec induction is the induction from HELL and will avoid it at all costs!!!!
  9. by   bagladyrn
    I've become even more uncomfortable with using cytotec since the manufacturer came out with a memo stating specifically that it was not recommended for use in inductions. Of course, they are covering their own selves, but where does that leave the responsibility with a bad outcome?
  10. by   SmilingBluEyes
    I can remember a few very scary inductions w/prostin gel,also. It can be EVERY bit as unpredictible as cytotec. The difference is, at least, it is INTENDED for cervical ripenening as one of its uses...UNLIKE cytotec. As usual, cytotec is being used as a $$$ saver. That is always the bottom line, isn't it?
  11. by   at your cervix
    We only use cytotec on early IUFD's. Too risky to use it on full term live babies.
  12. by   moz
    We use 25mcg vaginally, the doc inserts 1st dose, and nursing may insert subsequent doses.
    My last baby was a cytotec baby- I went from 4 to complete in less than an hr, had shoulder dystocia also. My other labors were loooooooooooong.
    One of our pts had cytotec in the am, did nothing really all day, sent her home in the evening with no change. She went a mile or so down the road to eat, felt the baby "ball up", came immediately back to the hospital and delivered her own baby in the car while hubby was running in to get help! Babe and mom were ok thankfully. Now they stay overnight.
  13. by   KaroSnowQueen
    I am not an OB nurse, but isn't cytotec the med that comes with the sticker on it that women of childbearing age shouldn't touch it while administering it? Am I missing something here? Or have they changed their minds on this?
  14. by   SmilingBluEyes
    Karo, yes it generally is a DO NOT TOUCH drug for women of childbearing age.......in that it causes uterine contractions as a side-effect (cytotec is actually a drug for GI mucosal protection/ulcer tx). So if a woman is of childbearing age and unsure of pregnancy status or trying to get pg, she should NOT use this med. Of late, however, doctors have been using it to induce labor in women who either have experienced fetal demise or who are term or post-term and they wish to bring on labor. Its use for cervical ripening and labor induction on women with living fetuses has been called into question lately......very controversial. For all the reasons you see above, that is why. The controversy is far from over......and I predict many more doctors and hospitals refraining from cytotec use except in the cervical ripening of women experiencing intrauterine fetal demise. Just my thoughts...

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