Are they still using Cytotec?

rpbear · Jul 17, 2005

We use it for induction of IUFD, pp bleeding rectally, and only one doc uses it for induction, but usually after trying cervidil first. We do continuous monitoring on all inductions, cervidil, cytotec and prostin gel. I don't like the unpredictability of it, and the fact that it can't be removed like cervidil.

allnurses Guide · Jul 17, 2005

Yep, we use it.

steph

USA987, MSN, RN, NP · Jul 17, 2005

We only use it for PP hemorrhage and IUFD inductions...

BETSRN · Jul 19, 2005

Cytotec scares the cr*p out of me. It's much less manageable, it seems, than some of the other cervical ripening agents, and therefore less safe. I've heard that women are often not told about its possible side effects, and the fact that it's being used off label.
On another board that I frequent, someone said their homebirth midwife (CNM) wanted to use to help induce labor on a postdates woman. I was absolutely SHOCKED. I thought that with Cytotec, there was specific monitoring protocol, like with Pit or any other chemical intervention, to make sure you're not hyperstiming a woman or causing a rupture. And ruptures have happened frequently enough with Cytotec that I would be wary to use it without some serious monitoring.
Can the L&D RN's here tell me what their monitoring protocol is for Cytotec?
Alison

After placement, Mom is monitored for one hour. Then, Mom is free to roam and we monitor every 2-4 hours "depending on contraction pattern." Whenever she gets more active we swing into a more regular monitoring protocol. Personally, most of us hate using Miso. We much prefer Cervidil.

FrumDoula · Jul 20, 2005

For the nurses whose L&D units use Cytotec, how extensively are your pregnant clients/patients briefed on the possible side effects of Cytotec, and the FDA warning on it? I know tons of drugs are used off label, but I'm curious if this is also included in the paperwork they sign.

Thanks,

Alison

ravenwindrn · Jul 20, 2005

Dose your L&D ward still use Cytotec? Do you know if Cytotec was ever banned from being used in L&D? I know it was not approved by the FDA to be used in labor but doctors found "loop holes"

Yes, we are still using it. As a matter of fact, it's the ONLY cervical ripening agent we use. We also have a high c-section rate.

It's evil stuff. I hate it.

RNnL&D · Jul 22, 2005

For the nurses whose L&D units use Cytotec, how extensively are your pregnant clients/patients briefed on the possible side effects of Cytotec, and the FDA warning on it? I know tons of drugs are used off label, but I'm curious if this is also included in the paperwork they sign.
Thanks,
Alison

Our consents simply state "delivery and care of baby". However they are briefed on side effects, depends on the doc or nurse. I always explain the possible adverse reactions to Cytotec, Cervidil, and Pitocin. I'm unsure what others nurses do. I feel it is my responsibility to explain Cytotec the same as I would Nubain, or Vistaril, or Brethine......

Unfortunately, some patients don't really care.

CEG · Jul 22, 2005

I was induced with cytotec with my daughter. I had to sign a waiver that stated it was being used off label and was not approved by the FDA for that use. It also outlined the risks and gave statistics. Interestingly, I was familiar with it because the same one was passed around in my Bradley class so I had read it before and done some research. I would say they definitely attempted to make me aware of the risks, although who knows if most people really read those things.

For the nurses whose L&D units use Cytotec, how extensively are your pregnant clients/patients briefed on the possible side effects of Cytotec, and the FDA warning on it? I know tons of drugs are used off label, but I'm curious if this is also included in the paperwork they sign.
Thanks,
Alison

SmilingBluEyes · Jul 22, 2005

Our consents simply state "delivery and care of baby". However they are briefed on side effects, depends on the doc or nurse. I always explain the possible adverse reactions to Cytotec, Cervidil, and Pitocin. I'm unsure what others nurses do. I feel it is my responsibility to explain Cytotec the same as I would Nubain, or Vistaril, or Brethine......
Unfortunately, some patients don't really care.

sounds very familiar. I never ever do anything w/o knowing the patient understands the rationale, risks and benefits to our interventions. It's how I have always practiced. It's the ethical thing to do.

midwife2b · Jul 22, 2005

Where I work as a L&D nurse, we don't use a lot of Cytotec for inductions or ripening, mainly IUFD's and PP hemorrhage. I did midwifery training in places that used it exclusively (almost no pitocin and almost no cervidil) because of the cost.

The nice thing about it was the women didn't have to be continuously monitored (after 1-2 hrs they could get OOB and have intermittent monitoring).

I really haven't had any side effects. I've not had any decels... with hyperstim, I turn the mom on her side, maybe give a fluid bolus, but as long as the baby looks ok just try to ride it out. I always have some Terb if I need it.

Our cervidil pts have to be monitored continuously for the entire 12 hours. Are there places that only do a couple of hours? Would love some references so maybe I can change some practices...

RNnL&D · Jul 22, 2005

Our cervidil pts have to be monitored continuously for the entire 12 hours. Are there places that only do a couple of hours? Would love some references so maybe I can change some practices...

Ours too. Cytotec is one to two hours after placement. Cervidil is continuous.

Rose B · Jul 24, 2005

We give Cytotec 50mcg PO every 4 hours starting at about 2100. We must have a positive NST prior, monitor for 1 hour continuously after, then monitor for 15 minutes of every hour. We start a saline lock also. Then do a pit induction in the am. I recently had a grav 2 deliver within 3 hours after the first dose. Never had a primip deliver with just the cytotec.