Misoprostol

  1. I have for the past year started worked ig with Miso (cytotec) and have seen a big difference in the way it induces labor. Has anyone else worked with it and what do you think?
    •  
  2. 15 Comments

  3. by   OB4ME
    Personally, I don't like it! It's too unpredictable! Uterine hyperstimulation is much more common with this med than with others, such as Pitocin. And have you ever tried irrigating cytotec out of the vaginal vault during a fetal response to uterine hyperstim? Loads of fun! But-the doctors love it-probably because it often works better in inducing delivery. Vaginal or crash c-sect, same result, right?! (sorry for the sarcasm there!)
  4. by   PC

    I've had very good results with cytotec, with cautious and closely monitored use, it is safe and effective, and rarely fails.

    (yes - keep your terbutline handy...)

    Irrigation of anything out of the vagina is useless per the evidence - cytotec OR PE2 gel. moot point.
  5. by   vicbike
    We have been using cytotec for at least the last year and 1/2 with very good results. Recently we decided that we would not use the cytotec for vbac's as it is to unpredictable. But we all love it. the patients are allowed more freedom to be off the monitor and up and walking, they only need a saline lock instead of an IV, they can be in the jacuzzi after the initial period of 2 hours on the monitor after placement of the cytotec. We start our patients out with either a 25mcg or 50mcg dose, depending on dr preferences. A few times we have had to use terbutaline because of hyperstim, but not a lot. We have midwives in town that also use it alot. It is a more natural labor for their pts, as long as you have guidelines and follow them, We didn't like it when we first started using it, but now I think most of us think it is pretty great. It works also!!!! And it is a lot less expensive than pitocin and other meds we have tried in the past.
    Originally posted by Nino:
    I have for the past year started worked ig with Miso (cytotec) and have seen a big difference in the way it induces labor. Has anyone else worked with it and what do you think?
  6. by   Nino
    Originally posted by vicbike:
    We have been using cytotec for at least the last year and 1/2 with very good results. Recently we decided that we would not use the cytotec for vbac's as it is to unpredictable. But we all love it. the patients are allowed more freedom to be off the monitor and up and walking, they only need a saline lock instead of an IV, they can be in the jacuzzi after the initial period of 2 hours on the monitor after placement of the cytotec. We start our patients out with either a 25mcg or 50mcg dose, depending on dr preferences. A few times we have had to use terbutaline because of hyperstim, but not a lot. We have midwives in town that also use it alot. It is a more natural labor for their pts, as long as you have guidelines and follow them, We didn't like it when we first started using it, but now I think most of us think it is pretty great. It works also!!!! And it is a lot less expensive than pitocin and other meds we have tried in the past.
    Thanks for the postive input. I have been in OB for 26 years and it is very hard for WOMEN to give positive responses to others!!!
  7. by   all alone
    When we first started using Cytotec, I really did not like it. I think it was a lack of control issue (with pitocin you can control the pump). However now we have been using it for about 2 years and I love it. Our policy states that if the patient comes in for her induction and is already contracting every 5 minutes or less, we do not use the cytotec. Occassionally I have had to use brethine, but overall I think that it works really well. I am curious to here how other facilities use cytotec. I know some use it PO. We only use it intra-vag and do not allow our patients to get up for 4 to 6 hours after administration. Please respond if anyone else uses it differently with good or bad results.

  8. by   Cindy A
    We use both Miso and prostaglandin gel. Depends on doc preference. We keep Pts. on EFM for 1 hour post administration for both drugs.Patients can then be up to walk with intermittant heart tone checks. we give gel q3 hr. and miso q4. Usually see results right away with the gel, but not long lasting. Miso usually does notstart anything until second dose, but can last for several, several hours. Often we will send people home after a few doses of miso and they come back in during the night in active labor. We use miso both intravaginally and PO also depending on doc preference. I have seen no difference in results between routes of administration. I have conducted my own unofficial study and have found that patients who have hx of bad menstrual cramps, nausea, vomitting, diarrhea when they have periods, are very sensitive to these drugs. I keep Terb with me for those patients. Overall, I think it works pretty good and have not had too many hyperstims with it.
  9. by   HazeK
    Originally posted by PC:

    Irrigation of anything out of the vagina is useless per the evidence - cytotec OR PE2 gel. moot point.[/B]
    where do I find "the evidence"? We are still "douching" out the cytotec w/ severe bradys, secondary to hyperstim...which is a *&^^*&^*&%$ during nursing interventions!! But we did try it, as IVP Terb. did not relax the uterus.

    Thankx Haze


  10. by   bbnurse
    Are any of you who use cytotec aware that the manufacturer has sent letters to depts and to physicians telling them that it should not be used for labor induction, nor in pregnant women at all?
    Ask your pharmacist and your director...they got the same one..I'm sure.
    It clearly states that it should NOT be given intravaginally to induce labor.
    BIG RISK managment issue.
    I'd not be the one administering it
  11. by   HazeK
    Originally posted by PC:

    Irrigation of anything out of the vagina is useless per the evidence - cytotec OR PE2 gel. moot point.[/B]
    Is this "moot point evidence" for VAGINALLY PLACED cytotec/prepidil or for INTRACERVICAL cytotec/prepidil ? or BOTH?

    Is this "moot point evidence" per your clinical experience or per literature review or per research data?

    I'd love to know which, as I still find myself doing 'douching' to uterine hyperstimulation w/ accompanying fetal bradycardias that are non-responsive to the initial nursing interventions of "fluids, O2, single dose of IV Terb, repositioning, MD notification, c/s room readied, prayer......................

    rsvp please :-)
    Haze



    ------------------
  12. by   HazeK
    "Our policy states that if the patient comes in for her induction and is already contracting every 5 minutes or less, we do not use the cytotec."

    My L&D has been using Cytotec only for about two years...and only a few MDs! At first, I hated the lack of control (OK, I'm a control-freak when doing inductions...) but it is nice that patients can eat/drink/move around more than on pitocin. As an "all private MDs" facility, the MD orders & places it as he sees fit...NOT by a unit-wide, accepted, researched protocol! I *really* loved the quote above, especially the word "policy", as I feel the administration of Cytotec definately needs some guidelines because it is so new to us, and many others. The one "decel from hell" w/ uterine tetany that I had to deal with was on a multip that was contracting BEFORE the cytotec was placed!!! I prayed long & hard for those heart-tones to come up, while doing all the "other stuff"! And I do worry more about VBACs...should I??

    Anyone have Cytotec policies to share???

    P.S> We have been using "aggressive" Cytotec on mid-trimester labor inductions for several years, with quick labors & less discomfort to the moms. (like for stillborns, anencephaly, etc.)

    ------------------
  13. by   HazeK
    Originally posted by bbnurse:
    Are any of you who use cytotec aware that the manufacturer has sent letters to depts and to physicians telling them that it should not be used for labor induction, nor in pregnant women at all? Ask your pharmacist and your director...they got the same one..I'm sure. It clearly states that it should NOT be given intravaginally to induce labor. BIG RISK managment issue.
    I'd not be the one administering it
    Terbutaline is **NOT** FDA approved in pregnant women either...........
    I use it daily on the job! The real reason Cytotec is NOT FDA approved is the
    almighty $$$ (same reason why terb/brethine isn't) It would cost too much to go back & do all the studies to get approval...then, the low cost of Cytotec (one of it's best qualities) would jump as high as the costs are for Prepidil & Cervidil!!!

    for legalities-sake, have policies in place, MD/Midwife placement only on viable pregnancies, use common sense, be aware of the current studies "out there" and chart lots! The community standard of care is important to know!

    Who knows?!? maybe someone will be suing us for a c/s for a failed induction because we DIDN'T use cytotec, when it was the S.O.C. in the community!

    hang in there!

    ------------------
  14. by   HazeK
    OK...I'll shut up now about Cytotec....sorry for babbeling on 'ad nauseam' :-)

close