My hospital will soon be using Cytotec for labor induction. I wondered if anyone out there has used this drug for inductions before, and what your opinions were on that. The literature seems to indicate that if you use a small dose and don't redose for 4 hours, that things should be fine, but I can't shake the horror stories that are in the literature as well. Any one with experience with Cytotec for inductions, please post and let me know your thoughts.
Steel Town RN
Aug 5, '03
We use it, and it works well. Sometimes it really moves things along quicker than we're used to with our good ol' cervidil. It's great with a cervix that isn't ready for pit. We give 100mcg q 4-6 hours, but there are stipulations such as if they're contracting >2 in 10 min with some pain, we hold off. There is also a list of contraindications that would restrict our use in certain patients. Some of the nurses don't love it, but I like it a lot better than cervidil, and it's much easier to administer!
Aug 5, '03
Thanks for responding. Can you elaborate on what the contraindications are? The only ones I'm aware of are: low Bishop score (obviously), and having 5 or more past pregnancies. Are there more? Thanks in advance.
Aug 5, '03
I find cytotec VERY UNRELIABLE AND UNPREDICTABLE AT BEST. I don't like using it all, but we do for cervical softening/ripening, mostly in preparation for pitocin induction. It can either work VERY well and send a woman into labor fast (even to hyperstimulation), or do nothing at all. It's hard to say--- and when I teach my patients about what they are consenting to do, I make its unpredictibility VERY clear to them.
WE don't use Bishop's scoring where I work. Main contraindictions for cytotec use are: TOLAC, Fetal indicators of distress, and already actively laboring (obvious). We give 25 mcg (1/4 pill) vaginally, placing that tiny pill behind the cervical os. They have to lay down on their side for 30 minutes and have continuous monitoring for 1 hour. We can give 25 micrograms every 3 hours up to 3 doses to try and ripen the cervix or induce labor. The other places I worked, we gave 50 mcg orally for the same hoped-for effect.
I have seen a couple of scary situations and poor outcomes that seem to link to cytotec use, so I use it cautiously and with not a little trepidation. I keep Brethine in my pocket as hyperstim is NOT unheard-of with cytotec use. It's tough, cause unlike cervidil, once in , you can't remove it, and unlike pitocin, you cannot turn it "off". You better be strong in fetal heart monitoring and intrauterine resuscitation skills if using cytotec; need to know all the implications and/or risks you are taking using this unpredictibile drug. AND we are using it Off-Label remember!
Aug 7, '03
We just recently started using it instead of cervadil, mainly because it is a lot cheaper. Our policy and dosing is simillar to Smiling Blue Eyes. It seems to work well for cervical ripening and about 1/2 the time we never have to go on to Pit. But we haven't had any problems yet either. We begin dosing at about 6pm with intentions of starting Pit at 6am. Where we are having problems is staffing (we are very small) if the patient decides to go into labor during the night. We have to make sure we have someone extra on call.
I want to try it for pp bleeding. I haven't convinced our docs yet.
Aug 7, '03
It is GREAT for PP bleeding. 1000 mcg rectally shuts it down FAST and without all the contraindications for methergine (not to mention shortages of this drug) and hemabate (expensive!). I have seen this drug in action in PP hemorrhage to know it WORKS!!! Just like pitocin, it's entirely a different animal when used AFTER birth. Before, in labor, you best know what you are getting into.
Sep 19, '03
To quote one of our Ob doc's... "We're to smart for that"
David Adams, ARNP
Sep 21, '03
Rarely we have had to give terbutaline or mag to stop the rapid no resting tone contractions one can get with cytotec, and we have the docs give it , much to their dismay..At the place I now work, there is a lot of cervidil used instead of cytotec and both are equally unpredictable in my opinion..Does work wonders for the pp hemorrhage patient and not as messy as hemabate can get...
Sep 21, '03
On the subject, get this...really scarry to me!!!
Had a patient the other night who was contracting every 1-2 minutes "on her own" but only lasting 30-50 seconds. So the doc orders Pit, and the nurse before me starts it right before report. Well patient had some small variables, almost looking late in onset but fast to resolve. So I finish getting report go in and assess my patient, the pit had been on at 1mU for all of 5 minutes and she is not relaxing, adjust the toco and she is coupling and tripling. So I turn off the pit and sure enough still contracting q 1-2 very uncomforatble, I was told she had a low tolerance, come to find out she had a particular MD that would insert 25mg Cytotec in the clinic, she had an appointment earlier that day, pt had no idea about the cytotec, so Pit is now permanently off, and she delivered a few hours later and after the onset of non reassuring heart tones! Baby and mom are luckly fine. But what a lesson to learn!!!
Anyone else have this happen???
Sep 22, '03
Cytotec earned the nickname Cytoblast at one hospital I worked at. If it worked, it tended to work a little too well. I have seen a fair amount of hyperstimulation with it and also tend to carry terb in my pocket. I have used it intravaginally and PO for induction and also rectally for pph but only 400 mcgs dose. I had a Mom with a significant pph recently and sure would have loved to have an extra 600 mcgs where the sun don't shine.
Sep 28, '03
We use 25 mcg in the posterior fornix q 4 hours up to 3 doses for cervical ripening. Followed by Pit 4 hours after last dose, if needed. We have the pt side lying for 1 hour, with 2 hours of EFM.
I have noticed that the CNM's seem to like it more than the docs do. The docs go for the Cervidil. I assume the EFM protocol has something to do with it. Cervidil requires continuous monitoring, while Cytotec is 2 hours post admin.
Sep 29, '03
I didn't think we were ever able to use 100mcg of Miso except maybe for a fetal demise. We use 25 mcg. It is MOST unreliable and we all prefer cervidil to Miso.
We've actually gotten away from using much Miso because of the potential for bad problems associated with its use.
Sep 29, '03
I was curious about that dose too. We only use 100 mcg for fetal demise.
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