Is there anyone using cytotec to induce labor? How is it working out? Do you like it? Are you seeing any complications?
May 1, '99
I worked as a nurse extern for the past year on a unit that used cytotec some. Several of the nurses talked about the cytotec "blast." i.e. the dialation would be pretty slow then all of a sudden we'd have the baby at a +2 sation. I saw two precip deliveries using cytotec (I worked nights-no docs in house). However, it certianly did not happen with every patient who got it. The nurses on the unit seemed to prefer the prosaglandin gel and pit if needed.
May 11, '99
Call the University of Washington's Labor and Delivery Unit and ask for their protocol and the results of their study.
[This message has been edited by travelnurselisa (edited May 11, 1999).]
Jul 1, '99
I work in a very small hospital (200-230 deliveries a year) and we have just started using cytotec for induction or augmentation and have had good results so far. We generally use it intravaginally placed high in the posterior fornix. So far the discussion at work has been that it is a less expensive form of induction that has so far worked faster that prepadil and pitocin. We plan to try it more frequently to get a better idea of it's effectiveness. I give it a thumbs up!
Jul 5, '99
We have been using cytotec at our hospital for several years. For awhile it had replaced pitocin (except in vbac's) It is great to ripen a cervix. Our doc's start out with 50 to 100mcg PO about q 4hrs. I've observed:hyperstimulation (resulting in either terbutaline or stat c/s..so always have an IV in), labor times have been shortened to about 12 hrs on average if mom is closed and thick, due to the fact that cytotec is hard to "control" some of our doc's now use cytotec in cervical ripening then switch to pitocin later on in labor. By hard to control, i mean that sometimes contractions start out great (q2 to 3 mins 15 mins after administation) but then slacks off (our policy prevents re adminstration of cytotec or pitocin within 4 hours of cytotec) If any one is doing a study on cytotec in labor I would be interested in some numbers/outcomes.
Jul 6, '99
Hi there. I work in a 16 bed LDRP that also has 10 gyn/section rooms, And we are always full. We used to only do 120 deliveries a month, which was nice. Now we are doing 170-190 a month. we have recently started using cytotec. I have very mixed feelings about it. Some Doctors are using it in the office, sending pt home, come back for 2nd dose, then send them to the hospital. WITHOUT ANY MONITORING> This greatly worries me. Pts come in and are hyperstiming and the baby is NOT tolerating it. Have to do a lot of c sections. Other physicians are using it, and monitoring closely and it can work wonders. Most of the time, no pitocin is needed. We have used it po maybe once or twice. And in that case the baby did not tolerate the labor and we had to section her. Anyway, I don't think we have used it enough to really come up with any strong evidence. I'd love to be able to track outcome and apgars on these babies.
Aug 3, '99
We have been using Cytotec at my hospital now for a couple of years, vaginally and orally. I can tell you that the general concensus from my coworkers and me is that we HATE it. Hyperstim occurs frequently and Terb does very little to alleviate it. Most of our docs bring them in in the evening, dose them and then have us dose them at least once more in 4 hours. We sarcastically call it Pitocin from home. Some patients do deliver very quickly, so quickly in fact that they do not even get to think about pain meds or epidurals. Those that don't deliver during the night, are up all night anyway then are given Pit in the morning. They are usually exhausted by the time they deliver. I have had many patients that were very dissatisfied. At another hospital in my area, a primagravida ended up with a ruptured uterus. I think that Cytotec needs to be more thoroughly researched. The bottom line is that doctors like it. End of story!
Feb 9, '00
We use cytotec alot. We are a small hosp. with about 50 del. a month, but have replaced cervadil completly with cytotec. We only use it directly on the cervix and we start out with half of a 50mg. tab. for the first dose. and repeat q4. We ask the pt. to stay in bed for 2hours after insertion(on monitors) and then we walk them for 1hour. Usually one or two doses works. Occasionaly after two doses we have to start pit.
Feb 16, '00
When a couple of physicians transferred from another hospital to ours, they brought over the practice of using cytotec. The general consensus here is it's awful!!! Using it po is somewhat better, but most of our docs use it vaginally; 80-90% of the time, the pts. get hyperstimulated and the babies get completely stressed!! We've had some stat c/s from it; once it's placed, you can't take it out!!! We hate using it...but if you're going to do it, ALWAYS have an IV in, and don't place it if you don't have a good baseline strip!
Nov 9, '07
We use cytotec for almost all inductions. Most of the MDs start with 25mcg intravaginally. With either the same dose again in 4 hours or 50mcg. Monitor for 2 hours post insertion the OOB or tub or whatever. Very little hyperstim when this pattern is followed. Some docs like to start at night and give a sleepingf pill after the 2nd dose and the patient sleeps a few hours then is awake in great labor. We haven't seen any stressed out babies except when the doc is impatient and puts 50 in to start and another in 4 hour even when we are having 3 min contractions. It takes a while with primips but does usually kick in.
Nov 10, '07
I work in a small rural hospital and we use it alot. I would say about 99% of our inductions start out this way. Usually the docs bring them in at 10pm, get a reactive strip on baby, place cytotec vaginally, have them lay down for 1 hour to monitor, walk them for an hour then give them ambien let them nap. Around 4am, get another reactive strip, place another cytotec , monitor q1hour, then they can either go back to sleep or walk. We don't place the 2nd cytotec if they are actively contracting ( q2-3 min) or have made significant change or if baby isnt reactive. Then if that doesnt work they either start Pit or AROM. Most of our moms deliver within 12 hours, some more some less depending on if they were already dilated before the start of induction or if they are not a G1.
Apr 10, '08
We use Cytotec vaginally at our hospital, usually 25 mcg, maybe 50 mcg. And many times, one dose is enough. I think it works better for someone who has already had a child or two. Inductions are not as successful for primes. We used to send people home if the induction failed but not any more. Once the pt. comes in for an induction she doesn't go home until she delvers. which sometimes means a C-section. Inductions in general are cuasing more and more sections. It would be nice if more mothers were informed enough to question this practice of inducing labor.
Apr 14, '08
This is the protocol I use for miso to ripen a cervix: 50 mcg q 3-4 hours po x 5 doses prn. I sleep them overnight and then pit in am if needed. I find it works great on an unripe cervix and have not had any hyperstims.
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