Survey about Cytotec

Specialties Ob/Gyn

Published

I'm just doing some research on cytotec placement/ inductions. Our Facility is pushing for nurses to place cytotec. We are a small rural hospital (300-400 births a year). We just got a new OB/Gyn who came from a larger hospital that has nurses do almost everything. I am guessing that to get him to sign on with us, they told him we would do all the things the bigger city nurses are doing. Most of us are rather ucomfortable with the idea due to the fact that we do not have any doctors in house during cytotec inductions if the nurses are placing them. We also do not have a surgery crew in house. I was just wondering what you ladies do at your facilities - thanks

How many births do you do per year or per month?

How many OB/gyns do you have on staff?

How many family practice doctors delivery babies?

How many nurses do you have on staff for L&D for each shift?

Do nurses place cytotec or do the doctors do it?

Are there any nurses that refuse to place cytotec?

Are their doctors in house during the cytotec induction?

Is the surgery crew in house during cytotec inductions?

If you place cytotec,what was required to train you to place cytotec?

Is Cytotec used on viable pregnancies or only on IUFD?

Do you or would feel comfortable placing cytotec?

Specializes in L&D, postpartum, nursery, antepartum CLC.

One of you said that you have the patient sign a consent. how many other facilities have the consent forms for their patients to sign? Does anyone have a copy of the consent form that i could get?

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Specializes in Obstetrics/Case Management/MIS/Quality.
one of you said that you have the patient sign a consent. how many other facilities have the consent forms for their patients to sign? does anyone have a copy of the consent form that i could get?

i was the one who said to have the patient sign a consent. our patients signed consents for any induction or augmentation procedure with pitocin and/or cytotec. we just used the basic generic hospital consent form and filled in the information in the blank lines at the top where you have to write in what procedure they are consenting to.

i read somewhere, however, that you should really be having the patient sign a consent that explains they will be given a medication that is not approved for the purpose of labor induction (off label use)....i'd be curious to see if there are any hospitals that go to that extent. this is a great discussion btw! :up:

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Specializes in perinatal, addictions/behavioral health.

A few good sites to visit concerning cytotec studies and its use for labor induction are the world health organization's site http://www.who.int and the cochrane collaboration's site http://www.cochrane.org, which has excellent independent reviews of research material on all kinds of topics, including cytotec induction :).

The pharmaceutical company that produces cytotec is Searle. They have a good bit to say on their website http://www.searle.com concerning the use of the medication in a pregnant population.

Good luck in your research!

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Specializes in Ante-Intra-Postpartum, Post Gyne.

I just got hired and am not working yet so I can not answer all your questions. But I can tell you that one of the reason's I chose the hospital I got hired at was because they DO NOT DO cytotec inductions. Its not off label its against label.

As I am sure you know, Cytotec is misoprostol, the same drug used for medical abortions.

Midwifery today wrote several articles warning against this:http://www.midwiferytoday.com/cytotec/

I did some training at an awesome hospital that I would love to do part-time for some day that used it, but at very low doses which is suppose to be safer. I think I would be comfortable with that, but only they very low dose; but I still wish it was not used at all.

But then again, Pitocin is off label for labor...but most drugs are not tested on prego women...

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Specializes in L&D.

I'm reeeeeeeaaaalllly surprised that cytotec is still so widespread and doubly surprised that it's used so often in smaller hospitals without an OB on the premises. My current job (6000+ deliveries/year, teaching hospital, understaffed of course!) does not use cytotec except in IUFDs or non-viable inductions. Even though we are frequently DESPERATE for an open labor room we leave cervadil in for up to 24 hours. Our inductions go very slowly, but at least we're comfortable in the knowledge that is a woman hyperstims we can take the cervadil OUT! Other than that, they get pit. We never do mechanical foleys either. It's cervadil, pit or nothing.

My last job placed 25mcg cytotec PV once and then 25mcg more q4 (or was it 6?8?). I think we topped out at 3 placements. So I'll answer for THAT job!

How many births do you do per year or per month? 3000

How many OB/gyns do you have on staff? 1 attending, four residents.

How many family practice doctors delivery babies? NA

How many nurses do you have on staff for L&D for each shift? Supposed to be 8, was always 5 or 6.

Do nurses place cytotec or do the doctors do it? Residents only.

Are there any nurses that refuse to place cytotec? NA

Are their doctors in house during the cytotec induction? Always

Is the surgery crew in house during cytotec inductions? Always

If you place cytotec,what was required to train you to place cytotec? RNs didn't plac eit, and believe me, they would have refused.

Is Cytotec used on viable pregnancies or only on IUFD? Yes, but a far higher dose. PV and PO.

Do you or would feel comfortable placing cytotec? No freakin' way. Not unless there was a surgical team in house.

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Specializes in Antepartum, L&D, Postpartum.
One of you said that you have the patient sign a consent. how many other facilities have the consent forms for their patients to sign? Does anyone have a copy of the consent form that i could get?

We use the generic consent form that we use for everything else and write in "Cytotec induction of labor".

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Specializes in L&D, postpartum, nursery, antepartum CLC.
I'm reeeeeeeaaaalllly surprised that cytotec is still so widespread and doubly surprised that it's used so often in smaller hospitals without an OB on the premises. My current job (6000+ deliveries/year, teaching hospital, understaffed of course!) does not use cytotec except in IUFDs or non-viable inductions. Even though we are frequently DESPERATE for an open labor room we leave cervadil in for up to 24 hours. Our inductions go very slowly, but at least we're comfortable in the knowledge that is a woman hyperstims we can take the cervadil OUT! Other than that, they get pit. We never do mechanical foleys either. It's cervadil, pit or nothing.

My last job placed 25mcg cytotec PV once and then 25mcg more q4 (or was it 6?8?). I think we topped out at 3 placements. So I'll answer for THAT job!

How many births do you do per year or per month? 3000

How many OB/gyns do you have on staff? 1 attending, four residents.

How many family practice doctors delivery babies? NA

How many nurses do you have on staff for L&D for each shift? Supposed to be 8, was always 5 or 6.

Do nurses place cytotec or do the doctors do it? Residents only.

Are there any nurses that refuse to place cytotec? NA

Are their doctors in house during the cytotec induction? Always

Is the surgery crew in house during cytotec inductions? Always

If you place cytotec,what was required to train you to place cytotec? RNs didn't plac eit, and believe me, they would have refused.

Is Cytotec used on viable pregnancies or only on IUFD? Yes, but a far higher dose. PV and PO.

Do you or would feel comfortable placing cytotec? No freakin' way. Not unless there was a surgical team in house.

LOL I think I like you! we currently have the doctors placing cytotec pv and we do 25mcg every 3-4 hours with a max of 4 times equaling 100mcg. We typically do cytotec inductions on night shift (that only has 2 staff members - no matter the census, that may only include one nurse that's labor trained) and start pitocin in the morning either after the 4th dose or, if they need it, after ROM during the night. I have found that cytotec is VERY effective - far more effective then cervidil - and I feel comfortable with these inductions as we do them now - I would even go so far as to say that i would consent to a cytotec induction myself with my doctor and the nurses i know monitoring me. The doctors tend to not like staying in house to place it every 3-4 hours, but they are all very committed to being there for their pateints and are willing to do it (most hospitals in the area, a woman has a 5% chance of having her doctor actually deliver her baby, here it's 95%) However this has now all changed since the new OB is coming form a facility that does 5000+ births a year, has residents and on call OB's in house and a surgery crew in house and on the floor, to a hospital that does 350-400 births, has no in house oncall for dr.s or OR crew and the OR suite isn't even on the floor. He seems to be having some culture shock and seems to want to bend us to be more like the big city hospital, which of course isn't possible since small rural practice is inherently different from the large urban practice. Hence the reason for my research i want to be prepared for an open and frank discussion regauding this issue and this sort of information helps me out a lot.

Thank you to all you wonderful nurses for helping me out and please, i would love to get more information so keep it coming!

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Specializes in L&D/postpartum.

How many births do you do per year or per month? Around 800-900/year

How many OB/gyns do you have on staff? 4 OBs, plus 2 midwives

How many family practice doctors delivery babies? 3 or 4, not very frequently though

How many nurses do you have on staff for L&D for each shift? We are an LDRP unit, so 3-4 on days, 3 on nights, but usually only one person is dedicated as the labor nurse unless things get crazy

Do nurses place cytotec or do the doctors do it? Doctors do it

Are there any nurses that refuse to place cytotec? n/a

Are their doctors in house during the cytotec induction? Not necessarily, they can place it and go home.

Is the surgery crew in house during cytotec inductions? No

If you place cytotec,what was required to train you to place cytotec? We don't place it.

Is Cytotec used on viable pregnancies or only on IUFD? Both, usually higher doses for IUFD though

Do you or would feel comfortable placing cytotec? I would feel comfortable, but I'd rather not do it because it would be yet another reason for docs to not to come in for their patients.

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Are there any nurses that refuse to place cytotec? The pregnant nurses do not place it, other than that, NO, everyone places it.

.

Why don't the pregnant nurses place it? Is it a handling issue? Just seems a little strange because they should be wearing gloves anyway to place it...

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Specializes in perinatal, addictions/behavioral health.

The reason that pregnant nurses do not handle cytotec is because with each dose received from the pharmacy there is a warning to keep it (the cytotec) away from pregnant women because of its powerful abortifacient properties. At least that has been my experience.

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The reason that pregnant nurses do not handle cytotec is because with each dose received from the pharmacy there is a warning to keep it (the cytotec) away from pregnant women because of its powerful abortifacient properties. At least that has been my experience.

Interesting. Just curious as I placed it several times daily while pregnant with no issues. I did handle it with gloves.

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Specializes in L&D, postpartum, nursery, antepartum CLC.
Interesting. Just curious as I placed it several times daily while pregnant with no issues. I did handle it with gloves.

I was told by our pharmacy that even through gloves (they are slighty porus - hence why one should wash their hands after cares even when using gloves) are used the negative effects can still be absorbed into the skin in high enough doses to cause a negative conequence.

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