Cytotec

[Brookesmom]

Is anyone else using Cytotec po for inductions? We have just started using it orally and it really seem to work well. Has anyone else that has used it had any problems?

[Solo36]

Brookesmom, Hello!! I was beginning to wonder if anyone else used Cytotec. We have been using it for 2 and one half years now. It works so much more quickly than Pitocin!! We use 100mcg p.o. only after having obtained Reactive NST, then repeat same dosage every 4 hours. The only drawback I have experienced is the initial tetanic contraction that about 30% of my patients get. We will have a fetal prolonged decel (into the 60's) during this episode, but it only lasts for about 3 minutes. I have only had 1 emergency c-section due to this when the baby's heart rate would not go back up. That is still better than my Pitocin c-section rates, and I have found that since we started using the cytotec, my overall c-section rate has dropped from a whopping 38% to a more manageable 25%. My other concern (and I haven't had any complications) is that it sometimes works so quickly that Mom's body isn't prepared!! I have had inductions go from the first pill to delivery within 1 and 1/2 hours!! The other great thing about it is that it even works on a unripe cervix. I have though had to send 2 people home after getting cytotec that just didn't work, but on the average, it is working on everyone we use it on. Let me know about your dosages and experiences with it.

Lisa;)

[ohfeelyafundi]

Hey Brookesmom!

I work in a small rural hospital and we do use cytotec on occasion. We are using it a lot less lately though! Our guidelines state that after we get a reactive NST (and the patient doesn't have any contraindications like previous C/S. asthma, vag bleeding etc...) we can administer the cytotec either po or lady partslly--whichever the MD orders. lady partslly, we give 25-50 mcg q 4hours until adequate UC's reached or a max of 6 doses. Orally, we give 100mcg q 2 hours until adequate labor with a max of 6 does. We also have to do VE's before any dose. We are to monitor the patient for 2 hours after insertion and absolutely not give anymore does with tachysystole, hyperstimulation or non-reassuring heart tones (duh!). We do VS q 2 hours and have parameters when to give terbutaline.

I feel fairly comfortable giving these doses. A few years ago we gave a lot more and we gave it buccally. It seemed like a lot of the patients had painful UC's about a minute apart--it was scary!!

I hope this helped!! Good luck!!

Kday--we use the PGE2 suppositories for our demise inductions--it works fantastically! Ususally it only takes a 10 mg. dose.

[fiestynurse]

Labor induction: Cytotec alert

It is becoming more common for hospitals to use Cytotec (misoprostol or prostaglandin E1) to ripen a woman's cervix and induce labor. Cytotec is a small pill that can be taken orally or broken in pieces and inserted lady partslly.

There are growing concerns about the safety of this drug when used for labor induction. A November 1999 Committee Opinion of the American College of Obstetricians and Gynecologists (ACOG) warns: "There have been reports of uterine rupture following misoprostol use for cervical ripening in patients with prior uterine surgery. Thus, until reassuring studies are available, misoprostol is not recommended for cervical ripening in patients who have had prior cesarean delivery or major uterine surgery" (1).

Cytotec's only FDA-approved use is treating ulcers. In August 2000, Searle, Cytotec's manufacturer, sent physicians a letter reminding them that Cytotec was not approved for use as a cervical ripening agent and that it was contraindicated for use in pregnancy (14). The letter listed serious adverse effects associated with using Cytotec, including maternal or fetal death, uterine rupture, and severe lady partsl bleeding and shock.

In our local facility it is only used for IUFD inductions.

[kennedyj]

From the articles on Misoprostil I think that Searle and the manufactures do not want to entangle themselves in the debate so they are following the cover your butt rule.

I think it boils down to the question of whether she really doe's need an induction and if her Bishop score is not adequate to use pitocin. So many times when you start a pit induction on an unripe cervix you end up turning it off and trying again the next day.

Prostiglandins gel (or Pig semen to be more politically correct) just doesn't work as well as cytotec and including repeated doese may cost up to $1000 in meds. Cytotec costs pennies. But not to put a price on safety. Cytotec works better for ripening the cervix. I haven't seen research but have heard of practitioners using it in lower doses and having lower risks of tetanic contractions and c/s. for example 25 MCG every 6-8 hrs. It takes longer but spreads peak medication times. Most places use 25-50mcg every 4 hrs religiously.

This may make a good research topic.

J

[ErinRN99]

When I was induced to have my son, they used cytotec on me, but they inserted it lady partslly. They could have done it 3 times, but after 1 it worked. I did end up having pit. later, but that was mainly b/c my epidural slowed down my labor so much...

[rdhdnrs]

In our teaching hospital we use cytotec for inducing non-favorable cervices or closed and soft. No cytotec after ROM, and generally none for PIH. VBACs don't get it either. We use it lady partslly or orally 25mcg to 50mcg q4.

For IUFD, the doses are 100-200mcg lady partslly or orally q4.

Our nurses don't give cytotec, the docs do. This is just a precaution since the way we're using it is an unapproved or off-label use.

[John Boy 2002]

We use misoprostol to induce labour of moms/families that have elected for termination of pregnancy due to genetic anomolies that are not capatible with life. The route is p/v as seen by decrease of side effects. The MD usually inserts or the mom may opt to self administer...Obviously an area full of controversy.

[mother/babyRN, RN]

We have used cytotec for several years now, both orally and lady partslly. At first, I protested it, only because the person who insisted we give it was basing administration on some article from the internet, and my feeling was that we should have a policy to cover ourselves if the nurses were expected to give it...

Finally, some one has listened to me and there is a policy officially being worked on. In the meantime the doc has to give it...I have had a few occasions where the cytotec caused little to no resting tone and we had to give terbutaline and mag to slow down the all too frequent contractions.

Mostly though, we have decent luck with it, though I find most of the people induced with it end up being augmented with pitocin anyway..Sometimes our docs will give a few doses, send people home and then wait for them to come in, in labor....

[rnoflabor2000]

It has it's pluses and minuses. It is really hard to insert 25mcg into the post fornix of the cervix, since the patients getting it are usually closed or fingertip and very posterior (not always). It's not like pit, you can't really turn it off, although terb works OK. Can't use it on prev C/S, that's a good thing. Works wonders on multips. It seems to need very favorable conditions to work right off the back. Some primips can be on it for days.

[nursechar]

Our facility has pt.'s sign a consent form stating the risks of the med and that the FDA has not approved cytotec for use in this manner. We usually use 25-50 mcg pv, and 100-200mcg pv for IUFD. Personally, it seems to work okay, but it's a little risky. Why not use Pitocin that can be turned off at any moment and has a very short half-life. We also use prostaglandin suppositories for IUFD, but it can make mom's have a fever and feel awful.