Cervidil Question

[adoptionacres]

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

[cnm in progress]

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.

[klone, MSN, RN]

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

I agree that Cytotec is more effective. However, I think that along with better efficacy comes greater risks. Cervidil can be removed if there is tachysystole. Cytotec cannot. We call it "Cytoblast" because what often happens is a woman gets 2 or 3 doses, her cervix is doing NOTHING for several hours, and then when she does go active, she goes from 2 to 10 in about two hours.

However, I think I did a Medline search for someone recently on the risks of Cervidil v. Cytotec and discovered that the research found no greater mortality/morbidity with Cytotec (and, like you and I have discovered, a statistically significant increased effectiveness).

[cnm in progress]

I agree that Cytotec is more effective. However, I think that along with better efficacy comes greater risks. Cervidil can be removed if there is tachysystole. Cytotec cannot. We call it "Cytoblast" because what often happens is a woman gets 2 or 3 doses, her cervix is doing NOTHING for several hours, and then when she does go active, she goes from 2 to 10 in about two hours.

However, I think I did a Medline search for someone recently on the risks of Cervidil v. Cytotec and discovered that the research found no greater mortality/morbidity with Cytotec (and, like you and I have discovered, a statistically significant increased effectiveness).

Definitely true regarding the inability to remove it after placement. As a practitioner, I know that I will pick and choose very carefully who is a good candidate for cytotec for that very reason.

I've heard cytotec called cytoblast by others as well. I'm curious... what dosage/frequency do you use. We use 25 mcg q 4 hours, and I've rarely seen that happen with it. I also wonder if there's any correlation with rapid progression and Bishop score on admission?

Interestingly, with as much as cytotec has been used, it's efficacy and safety are fairly well-documented. But the manufacturer will NEVER label it for use as a cervical ripening agent for several reasons:

1) There's too much liability with OB and they don't want to assume that risk.

2) It's a VERY cheap medication, so they don't stand to make much money from marketing it for OB use. The costs involved in getting it labeled for use in OB would be too prohibitive.

3) It's already being used for this purpose, so they're already making money. Why spend money to entice OB's to use their medication when it's already occurring.

[klone, MSN, RN]

I've heard cytotec called cytoblast by others as well. I'm curious... what dosage/frequency do you use. We use 25 mcg q 4 hours, and I've rarely seen that happen with it. I also wonder if there's any correlation with rapid progression and Bishop score on admission?

That's what we use, as well - 25 q4h.

I wouldn't think there is a correlation - the moms on which we use Cytotec all have very low Bishop scores (otherwise, we'd be using Pit).

[cnm in progress]

That's what we use, as well - 25 q4h.

I wouldn't think there is a correlation - the moms on which we use Cytotec all have very low Bishop scores (otherwise, we'd be using Pit).

Interesting. I'm thinking some women are really sensitive to it... and for others it does nothing at all.

[klone, MSN, RN]

Yeah, I'm not saying that ALL Cytotec inductions are that way, but when a mom precips so dramatically like that, Cytotec is often involved.