cytotec for retained tissue

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    Does anyone have any experience with cytotec/misoprostol for retained placental tissue? If it is given intravaginally, who gives it? How long postpartum is it effective? Does anyone have a policy/proceedure at their hospital that they could share? We just recently can across using cytotec for retained tissue after a routine pregnancy and delivery, pt. hemorraged post partum, had a syntocin drip 20 hours p.p., two doses of hemobate, passed a large piece of placental tissue day 4 p.p. and cytotec was started intravaginally on day 5 and orally on day 6. Pt. and babe remained in hospital for over 8 days. It seemed, at the time, that a good old fashioned D&C would have saved everyone time and money, and mom may have been able to successfully breastfeed had we got that tissue out. What do you guys think?
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    We have used rectal cytotec for PP hemorrhage, but if it's confirmed or suspected there are retained placental fragments, our dr's still do a D/C to remove it. I have not seen any of our docs use hemabate, methergine or cytotec to expel retained placental fragments. There are some nasty side effects that can come from extensive use of prostaglandins and oxytocins, as you know. They would have done the D/C to save the additional trouble and difficulty you describe here.

    I am intrigued; is anyone else doing this as well? I am always learning something new.
    Last edit by SmilingBluEyes on Nov 7, '05
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    We are talking about the little pill admistered vag to induce labor. I am by no means a L&D nurse but I had cytotec with my last baby. I remember thinking "now how is that little pill going to stimulate this big ole uterus"...hahahahah I wasent laughing long.. It works to stimulate contractions within the uterus and expelle any contents. I remember having 4 pills total and then BAM.. I delieverd in 2 hours.... So Im not a L&D nurse but this is my painful experience.
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    I have used cytotec for post partum issues....and one doc uses it for placentas after delivery of IUFD. Seems to me the practioner of the original post took the LONG way around to get that placenta out. Was there a contraindication of some sort that prevented surgical intervention?? 8 days...wow.
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    I've never heard of this...what is the rationale? Were they aware that she had retained tissue? Seems they should've taken her back and done a D&C...
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    I'm surprised to hear this. I would have thought that it would actually reduce the chances of the retained products coming out because it makes the uterus firm. Sure it can cause contractions in pregnant women but expelling a 7 lbs. baby is far different from expelling a tiny piece of tissue. With an essentially empty uterus I donít think the squeezing and expelling motions of the uterus would work like they do with a pregnant uterus.

    We use cytotec for cervical ripening, PP hemorrhage and delivering demises but have never heard of it for retained products. Makes me wonder if this was just an oversight and the patient was being treated for 4 days for PP hemorrhage when in fact she had retained products. Which would be negligence on the part of the MD because I've never heard of PP hemorrhage lasting 4 days. If it canít be resolved by meds, emptying of the balder then a D&C would be indicated. Of course it might be that this is just over my head and cytotec can be used for retained products.

    Anyone have a description of how the mechanics of cytotec for retained products works?


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