Are they still using Cytotec?

[HeartsOpenWide]

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"

[mari31666]

we use cytotec on a regular for diu's and for inductions. we monitor everyone continously. usually we see hyper stimulation and end up d/c it. then after a few hours of them still hypercontracting it will slow down. then we pit them. by the way i'd say most patients go on pit. out of 100 pts usually only 1 or 2 dont get pit and those are usually the ones that come in fd and deliver 5 mins after coming in triage. why do we pit everyone? is that common everywhere? just asking

[bunny722]

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.

I am an L & D nurse and we use cytotec all the time for cervical ripening. We use PO and PV routes. There is no waiver for patients to sign, and the doctors use it without giving the patients full, informed consent about the fact that it is not FDA approved and that it can cause uterine rupture! There are plenty of other drugs/methods we can use with much less risk. I for one will never let them use it on me whenever I have a baby!

[bunny722]

I cut and pasted this article, so I apologize the "form" is not better.

A 38-Year-Old Woman With Fetal Loss

and Hysterectomy

Benjamin P. Sachs, MB, BS, Discussant

DR DELBANCO: Mrs W is a married, self-employed, healthy

woman living in a community several hours from Boston.

She has private health insurance. At age 38, she was admitted

to the hospital for elective delivery of her first child, but

the admission ended tragically with fetal loss, hysterectomy,

and a prolonged hospitalization.

***********************************

Moderator note:

This appears to be an excellent article. I would ask you please post the link so we may access and read and possibly, discuss it. It's very cautionary! Thank you for understanding.

deb

[SmilingBluEyes]

please, refer to tos when posting articles from other sources:

copyrighted material:

no "spreading of copyrighted material": please do not upload, attach or post anything that is copyright or licensed without prior consent of the owner. for example, if you want to post content from an online article, do not post the whole article, post a partial synopsis, and then a link to the source.

[FrumDoula]

I am an L & D nurse and we use cytotec all the time for cervical ripening. We use PO and PV routes. There is no waiver for patients to sign, and the doctors use it without giving the patients full, informed consent about the fact that it is not FDA approved and that it can cause uterine rupture! There are plenty of other drugs/methods we can use with much less risk. I for one will never let them use it on me whenever I have a baby!

This is so criminal. Women should at least know that they're a guinea pig. I mean, to get a VBAC, you have to sign a million waiver forms indicating your informed consent, though it's often more of a scare tactic. But for Cytotec? Nada. Seems you only get to be informed if the doc or hospital wants you to be. Scary.

Alison

[SmilingBluEyes]

I can't imagine why they are being asked NOT to sign consents for this treatment.

Alison points out a valid issue: if we make them sign "their lives away" for VBAC then why not for cytotec/pitocin use (which have their own dangers).

Anyone?

[kastas, BSN, RN]

I'm bumping this thread up b/c it has peaked my interest. Sorry, I guess I missed it when it was being discussed.

Of those out there whom take it upon themselves to inform the pt of the pros/cons of pit/cytotec how exactly do you word it? I don't think saying, "hey this is not FDA approved and may cause uterine rupture" will get you far. How do you go about it?

[RNnL&D]

I simply say this is the reason for using Cytotec during pregnancy......., these are the possible adverse affects......., that is why we.........

Fill in the blanks. :)

[Mississippi_RN]

Our hospital is one of the last in our city to hold out on using cytotec. The scoop on cytotec is that when it was first tried and studied high doses were used. It came out being much more effective than cervidil and much less expensive. However this is also where you saw the adverse outcomes due to hyperstim.

When cytotec was then used in smaller doses the adverse outcomes went way down but so did effectiveness. It is no more effective than cervidil which is much easier to control (you take it out) than cytotec. All that remains is cost effectiveness (a few dollars for cytotec vs. $150 for cervidil).

However, if I were a patient or MD I would certainly think it was worth the money to use a safer drug that is specifically authorized for cervical ripening.

LOL... I worked in billing for years before becoming a nurse... At our hospital, they charge patients about $700-$800 for Cervidil.

[mom2dacl]

We currently only have one doc using it at our place for live births. others use it for IUFD's, but will absolutly not use it for cervical ripening for induction. I overheard one of the oldest docs in town telling a resident (today, in fact) how unpredictable it is, and how it can't be stopped efficiently if things go south.

Personally, I am terrified of the stuff. I hope that I don't end up in a cytotec induction with this doc, cause I might have to pull the "I am not comfortable with this" routine. This doc delivers at 2 hospitals, and often misses delivery's, runs out before writing orders, and has a very bad rep with the nurses.

So far, so good, however!

K

[mom2dacl]

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

Interesting. our protocol is 1 hour bedrest and 1 hour monitoring, then Q4hours or per nurse descretion for cervidil, but continuous with cytotec. (unless IUFD)

[msnicci]

At whose cost is Cytotec more cost effective. You should see the Bills after my sisters rupture! or the cost of her total life as result of the brain injurty she suffered from hypoxia. So Cost effective to whom is my question!!??