Cervidil Question

Anybody have a guideline on how soon cervidil can be repeated after it has been removed 12 hour after insert?

No, because using it for induction is off-label. Anyone with a guideline is shooting from the hip.

No, because using it for induction is off-label. Anyone with a guideline is shooting from the hip.

Are you thinking of Cytotec? The only use i know of for Cervidil is for cervical ripening. As far as repeating it after in place for 12 hrs. I am not 100% sure. We used Cervidil at the hospital I worked at back in the states and if memory serves correctly it was never repeated either because it worked or the doc would do something such as place a Foley ballon for additional ripening since Cervidl is very expensive.

No, because using it for induction is off-label. Anyone with a guideline is shooting from the hip.

I think you're mistaken. Cervidil is manufactured for cervical ripening. That's not an off-label use.

Even with off-label uses, doctors and hospitals still have usage guidelines, and that's what the OP was asking.

To the OP - we use cytotec, not Cervidil, for cervical ripening, so I can't answer your question, sorry.

You have to wait 30 mins before starting pitocin after removing cervidil, but I don't know of any restriction on re-inserting after removal. Must be a very thick cervix you are trying to ripen?

The practice where I work is to switch methods to Oxytocin or cytotec if the Cervidil does not work. I think this is more cost based than anything else though. You also need to look at why are you trying to get the baby delivered and which method is the best for the Mom & baby.

swise

Our policy is wait one hour but I have never seen it done. We usually try something different after that.

ldcmw

In our facility, if first cervidil is in for 12 hours & cervix is still thick, then second cervidil may be placed immediately upon removal of first. (I've only seen cytotec used here for fetal demises.)

Where I work, if the pts MD is one of the less harried ones and the conditions are favorable (meaning that the unit isn't packed to the rafters...betcha thought I meant the PATIENT'S conditions! Ha! I wish.) then they might place a second cervadil for an additional 12 hours. Or, weirdly, leave the original cervadil in place for an additional 12 hours. Depends on the doctor.

Usually, though, it's 12 hours on cervadil, an hour's rest, followed by pit.

Anybody have a guideline on how soon cervidil can be repeated after it has been removed 12 hour after insert?

No. Cervidil can't be repeated. According to my book "Intrapartum Management Modeles,"The manufacturer does not currently recommended more than one application of the cervidil because adequate studies have not been conducted on repeat dosing" (pg 226)

No. Cervidil can't be repeated. According to my book "Intrapartum Management Modeles,"The manufacturer does not currently recommended more than one application of the cervidil because adequate studies have not been conducted on repeat dosing" (pg 226)

Doctors and facilities sometimes (often?) use drugs contrary to manufacturer recommendations. That's simply the manufacturer's way of covering their own butts and getting themselves off the hook in case of litigation. The packaging of Cytotec says in big black letters "CONTRAINDICATED IN PREGNANCY" yet many facilities routinely use it as a cervical ripening agent in induction.

I think the OP was asking what other facilities and doctors do, not necessary what the manufacturer recommends, which are often two different things.

Doctors and facilities sometimes (often?) use drugs contrary to manufacturer recommendations. That's simply the manufacturer's way of covering their own butts and getting themselves off the hook in case of litigation. The packaging of Cytotec says in big black letters "CONTRAINDICATED IN PREGNANCY" yet many facilities routinely use it as a cervical ripening agent in induction.

I think the OP was asking what other facilities and doctors do, not necessary what the manufacturer recommends, which are often two different things.

Sorry I didn't realize there is a big gap between manufacturer recommendations and actual practices in hospitals. We don't use the second dose of cervidil in our hospital if the first dose fails. We use IV pitocin 30 minutes later after removing the cervidil. I think the book provides me the evidence of practice when it says "No" to the question,

" Can more than one dose of Cervidil lady partsl Insert be administered if inadequate ripening occur?" and give the explanation of manufacturer's recommendation.

No. Cervidil can't be repeated. According to my book "Intrapartum Management Modeles,"The manufacturer does not currently recommended more than one application of the cervidil because adequate studies have not been conducted on repeat dosing" (pg 226)

I did a little research, because I've never heard/read that Cervidil can't be repeated. I work in a very large, well-respected teaching hospital that is usually up-to-date on practice standards... and we've definitely repeated Cervidil in the past. I went to "Intrapartum Management Modules" and followed the reference given for this statement (the author references Forest Pharmaceuticals). According to the drug monograph for Cervidil:

"Cervidil is used as a single dosage in a single application."

It doesn't actually say that it can't be repeated at the end of the dosage/application. If the manufacturer has stated that it doesn't recommend more than one dose, it certainly isn't found within the drug monograph. I haven't found any evidence yet in the literature, but I haven't done a thorough search yet. If I find anything else I'll post a link.

On a side-note: I personally think Cervidil isn't worth its high price-tag. Misoprostol works much better and costs just pennies.