How do you monitor for cervical ripening?

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    In the process of rewriting policies/standards of care on monitoring for cervical ripening. The shift in our facility has been from cervidil and vaginal cytotec to oral cytotec, although we still do occasional cervidil. Here are our current monitoring protocols for LIVE inductions:

    Cervidil:

    Demonstrate reactive or reassuring fhr tracing for 30 minutes prior to initiation of cervidil. Once cervidil is placed (10mg to the posterior fornix of cervix), continuous monitoring x1 hour, then hourly fht's until cervidil dc'ed (12 hours max)

    Cytotec:

    25mcg vaginally every four hours with a maximum of three doses. Reactive NST or reassuring fhr tracing for 30 minutes prior to initiation of each dose of cytotec, and one hour continuous monitoring after each dose, then hourly fht's. No redosing if more than three ctx in 10 minutes.

    OR

    25mcg oral cytotec every four hours with a maximum of three doses. Reactive NST or reassuring fhr tracing for 30 minutes prior to initiation of each dose of cytotec, and one hour continuous monitoring after each dose, then hourly fht's. No redosing if more than three ctx in 1o minutes.

    Pitocin may be initiated after one hour of discontinuation of cervidil, or four hours after a cytotec dose, but requires 30" reactive/reassuring tracing prior to starting.

    I should note that cytotec/cervidil are never given to those with a previous uterine scar.

    The physicians are moving towards oral cytotec, mainly I believe since it doesn't require a Dr. in house to place the dose, it can be delivered orally.

    Struggling to find monitoring indications/evidence in regards to oral cytotec for a live induction. Any resources or recommendations appreciated. Thank you!
    Joe V likes this.
  2. 1 Comments so far...

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    I wish I could help but we only use cytotec to induce losses in Canada--never for induction of labor.

    For Cervidil induction we have to have a normal NST prior to placement and then monitor 1hour post insertion, then q4 hourly NST until removal. Pretty much the same for prostin gel inductions.


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