does anyone still us prostaglandin gel

[mark_LD_RN]

hi, does anyone still use prostaglandin gel to ripen cervix and induce labor any more we have not used it in about a yr or so. someone told me it was not being manufactured anymore.Is this true?

[SmilingBluEyes]

can you please refer us to the information you present here, Clare? I am interested. And for everyone else, do remember, this thread is over 3 years old.

[Spidey's mom, ADN, BSN, RN]

cause it costs way too much. cytotec is pennies compared to the cost of prostin gel. that about says it. that and they get to SWALLOW the cytotec, versus having something put into their cervical fornix.

No swallowing here . . . cut the pill into fourths and place it.

And it is a cost thing with us too . . .

steph

[SmilingBluEyes]

Steph:

That last post I made was 3 years ago, when I worked in a place where cytotec was administred orally. Where I work we place it lady partslly. I would strongly prefer oral administration, period. The same unpredictible results occur, no matter how it's given, I have long since learned. At least , it's less uncomfortable for the patient when I would hand her a pill to SWALLOW---- versus making her lay in bed, hands under her sacrum all while I am jamming a pill in the posterior fornix of her cervix-----only the to expect her to lay in bed, still, for an hour, head low so the stupid thing can be absorbed.

Not to mention, the method of delivery for the RN is a hellalot easier using the oral route! It's not easy trying to get that pill where it needs to go and not lose it first, IYKWIM! :rotfl:

[ClareLPN]

The funny thing is that I only ever heard of this because I am actually due to have my baby any time and an Aunt had told me about the gel. She said that on her eighth pregnancy (yes,8!) the gel was used and her baby had seizures and now has perm. brian damage...it's the only thing she can chalk it up to I guess. Anyways, it got me very worried:(

[madwife2002, BSN, RN]

You would get either the gel or pesseries if you were here in UK. At least in my hospital. I havent heard it has been discontinued yet? Cant believe it is not used in the US. Can you let me have ref to articles re cytotec. Ta

[SmilingBluEyes]

Cytotec (misoprostol) was originally marketed and used as an antacid. It's a prostaglandin (PgE) drug that is now used off-label for cervical ripening, labor induction and abortion induction in some places. Hope these links help those looking for more information:

http://babies.sutterhealth.org/laboranddelivery/ld_laborinduction.cfm

http://www.medscape.com/viewarticle/491697?src=mp

http://www.medscape.com/viewarticle/458959

http://www.acog.org/from_home/publications/press_releases/nr05-31-02-2.cfm

(this article discusses oral use of cytotec to induce labor)

http://www.misoprostol.org/c-3.html

(misoprostil site, see the right hand side for the actually uses/information)

Hope this helps!

[Jolie, BSN]

The funny thing is that I only ever heard of this because I am actually due to have my baby any time and an Aunt had told me about the gel. She said that on her eighth pregnancy (yes,8!) the gel was used and her baby had seizures and now has perm. brian damage...it's the only thing she can chalk it up to I guess. Anyways, it got me very worried:(

This is an example of faulty logic in terms of cause and effect. Just because she can't think of any other difference between this pregnancy and her others, she assumes that the prostin gel caused her baby's complications. Without other similar reported cases, and/or a randomized trial it is not scientifically sound to make such an assumption.

Maybe she used a new toothpaste the day she delivered. Would that have been blamed for her baby's seizure? How about french fries for dinner the evening before? That one event followed another (the seizure followed the use of prostin gel), does not imply cause and effect. Also, I would assume that some time passed between the insertion of the gel and the delivery of the baby. During that time, the gel is absorbed into the surrounding tissue, and/or flushed from the body along with amniotic fluid, lady partsl secretions, etc. It would not still be there for the baby to swallow.

I understand her grasping for an explanation for her baby's disabilities, but this is not likely it.

[SmilingBluEyes]

I agree Jolie. Plus REMEMBER: prostaglandins freely and widely cirulate in the labor process. It's a natural hormonal occurence, anyhow. I can't see how this drug was the cause of the problem in the case of that unfortunate mom and baby. However, IF anyone finds literature to this effect, I am highly interested in reading it. Most of what I read postulates (correctly) that incorrect or inappropriate use of prostaglandins can lead to failed fetal distress and necessary emergent surgery, and other such serious complications. As always, benefits need to outweigh risks in using prostaglandins and oxytocins! That is the crux of our problem when we have complications, I believe.

[RNnL&D]

For those that have used Cytotec orally, at any time, what was the dose compared to lady partsl placement?

[SmilingBluEyes]

Same dose, exactly. 25-50 mcg.

[Spidey's mom, ADN, BSN, RN]

Same dose, exactly. 25-50 mcg.

Deb - I have a pt who is getting cytotec lady partslly . . . . I asked the doc if giving it orally for the same purpose is ever done . . .he said "well, for inducing labor in an early fetal demise but not for inducing labor like we are trying to do". He also explained the uses for PP hemorrhage, etc.

He said he really had not heard of it done for normal pregnancies. And he is a fairly new doc . . .

Interesting.

steph

[SmilingBluEyes]

Well it is done EVERYDAY where I practice. I have issues w/induction of labor for non-medical reasons, anyhow, Steph. But that is another thread.