Cervidil

crysobrn · Apr 15, 2006

We have been using cervidil in our hospital for about 1.5-2 yrs now. Overall I really like it as opposed to using other cervical ripening agents. For one it is removable if your patient hyperstims or if fht's are not looking great. I find it's also easier to insert. I don't have our protocol right in front of me but we insert in the absence of reg mod ctxn's, after a cervical check. The pt is asked to lie relatively flat for a half an hour and stay in bed for about 2 hrs. The are to have at least a heplock or an IV at a kvo. The baby is to be monitored and documented every 30 min with ctxn pattern. VS are done every 30min x 4 then every hour til removal. The cervidil is removed for srom, fetal distress, hyperstim pattern, or after 12 hrs. fht's to be monitored for 30 after removal. Pitocin may be started an hour after removal. Which is nice because the pt can get up and shower. One thing I will tell you is the thing seems to work rather quickly on multips so just make sure things are ready. I've had moms deliver in a 2-3 hrs after insertion. Good luck with the transition.

babyktchr, BSN, RN · Apr 15, 2006

Can't add much more to the above post. It is very important that you institute CONTINOUS fetal monitoring after the insertion of cervidil. Don't let any doc tell you otherwise. I have read that pit can be started 30 mins after removal.

I am curious... why VS q1 hour??

rpbear · Apr 15, 2006

Our policy is very similar. VS q 4 hours after initial q 30 minutes x4, continuous monitoring, chart on UC's and FHT's qhour, MD or CNM inserts cervidil, RN can remove, pit can be started 1 hour after removal with reactive tracing. We usually let mom get up, shower and eat 30 minutes after removal as long as they are not in active labor.

I have seen it put many women into active labor, so be ready.

JaneyW · Apr 15, 2006

We used Cervidil at my last place--I liked it a lot. We let them get up and walk after an hour--so no continuous. I had the same experience with multips. It was frustrating, because I would have two Cervidil pts on the noc shift with the thought that I would be 'babysitting' them and end up with two deliveries by AM. They also had the thought that they didn't need an IV because they weren't in active labor--that was a mistake sometimes! I like the heplock idea. Wish we had done that.

babyktchr, BSN, RN · Apr 15, 2006

Oh yeah...been caught TOO many times with cervidil deliveries..so I am put those heplocks in just in case of anything....hyperstim, fetal distress yada yada yada.

SmilingBluEyes · Apr 15, 2006

Any cervical ripening (cervidil can be just as "dangerous" as prostin and cytotec) carries a lot of inherent risk. It's good to develop a sound policy to address these and be prepared for anything.

RNnL&D · Apr 17, 2006

We used Cervidil at my last place--I liked it a lot. We let them get up and walk after an hour--so no continuous.

I'm surprised by that. I have seen more than one Cervidil pt hyperstim. Our protocol requires cont. EFM for Cervidil. I thought that was pretty standard.

babyktchr, BSN, RN · Apr 17, 2006

Continuous monitoring is the standard of care. Since cervidil is long acting prostiglandin, it is considered an induction, even though it is for cervical ripening. Unfortunately, after a few lawsuits in conjunction with the use of cervidil, continuous monitoring is prudent. There was a case locally as a matter of fact that settled for I forget how many millions.. The jury found t negligence because no continuous monitoring was instituted and there was hyperstim and fetal distress because of it. When the monitor was finally put back on...terminal bradycardia was found and a CP child was born. Sad.

It is a pain in the butt to monitor them all night long...but in the long run...just a safe way to go.

SmilingBluEyes · Apr 17, 2006

I would agree that continuous monitoring should be standard of care. This should be for all artificial means of inducing labor or ripenening cervices. We are messing w/Mother Nature each time we do these things and I have seen a couple cases with my own eyes, where things went HORRIBLY wrong. Caveat emptor indeed.

ldcmw1 · Mar 12, 2009

I'm in agreement with the nurses who stated that a cervidil pt. should be on continuous efm. I can't believe a hospital would have a policy other than that!! Regardless of what the policy stated about intermittent monitoring I would do continuous efm. You could never get in trouble for being over cautious.

midwife228 · Mar 17, 2009

We also do continuous EFM with Cervidil and start Pitocin about 1/2 hour after taking it out (if needed). It seems like most women at least start contracting with it after a few hours and many multips deliver without needing the Pitocin. FYI - before our unit was staffed with midwives, labor nurses were allowed to place Cervidil as well as remove it.