Cytotec and fetal monitoring

Specialties Ob/Gyn

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I just started a job in a small hospital where Cytotec induction is routine. Our policy is to monitor the baby for 30mins before admin, then monitor for 2 hours. The nurses do not even check heart tones between that time. Is that a normal practice? The three L&D units I worked at did not use Cytotec at all for live births. I am very uncomfortable with the lack of cont fetal monitoring as I feel that Cytotec is in the same "high risk" as Cervidil, Pitocin, and Mag. Why is there a difference in fetal monitoring standards? Any ideas? I would like to feel better about it. (My background is high risk antepartum and L&D)

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Specializes in Family NP, OB Nursing.

When I was doing OB our policy was a reactive strip prior to administration, oral dose of Cytotec and then 2 hours of continuous monitoring followed by a minimum of 15min of continuous EFM/hr for the next two hours. Maternal VS were q hr. Prior to the next dose, usually q4h, strip must be reactive, VS stable and dose was held if UCs were 3min apart or closer or the patient was dilated 2-3. Once the patient was 2-3, we would start pit. Pit couldn't be started until 4 hrs after the last cytotec dose.

I know most people here HATE cytotec, at least from what I read, but we used it for almost every induction for more than 5 years and didn't have very many problems with it. The worst I can remember is a girl who chewed the pill and ended up with tachysystole and fetal distress within five minutes of ingestion, which led to a stat c/s for a healthy baby. Other than that, it worked well and much better than the cervidil or prepadil we used to use.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Cytotec is a good drug when used judiciously. It's contraindicated if you've had a previous C/S, and that's where a lot of the litigation and its bad rap came about.

Our policy is 30 minute prior (and reactive strip), then cont. monitoring for 2 hours after. Then if the strip looks good and she's not in active labor, we will take her off the monitor for 90 minutes, then put her back on for 30 prior to next administration.

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Our policy is get a reactive NST, oral cytotec, 3 hours continuous monitoring, off monitors x1 hour for ambulation etc... then repeat if needed. We'd hold it for the same reasons NPinWHC stated. I really like it for primips with a closed cervix.

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Specializes in Labor and Delivery.

I've never given Cytotec PO, just crushed lady partslly by the cervix along with Pit for induction and continuous monitoring. Is this policy anywhere else?

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
I've never given Cytotec PO, just crushed lady partslly by the cervix along with Pit for induction and continuous monitoring. Is this policy anywhere else?

crushed lady partslly? I've never heard of that. I would be concerned about hyperstim (excuse me, tachysystole). Plus, how does one apply a crushed tablet to the cervix, practically speaking? We do it either per vag (1/4 of a 100mcg tab, placed next to posterior fornix), or per buccal. What's nice about buccal is that it can be given even with PROM.

When you say you give it ALONG WITH pit - do you mean you give them both simultaneously?

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Specializes in Labor and Delivery.
crushed lady partslly? I've never heard of that. I would be concerned about hyperstim (excuse me, tachysystole). Plus, how does one apply a crushed tablet to the cervix, practically speaking? We do it either per vag (1/4 of a 100mcg tab, placed next to posterior fornix), or per buccal. What's nice about buccal is that it can be given even with PROM.

When you say you give it ALONG WITH pit - do you mean you give them both simultaneously?

When I was doing my capstone in L and D, yes it was tablet crushed and placed lady partslly posterior to cervix along with pit simultaneously.

Half the docs did this for induction, the other half were very much against using Cytotec and used Cervidil only. Obviously, I just did what my preceptor said/was ordered to do.

My first day of my L and D job starts tomorrow (SUPER EXCITED:D), I wonder what my new hospital's policy will be....:uhoh3:? I had just never seen Cytotec given PO and when everyone on here was talking about it, I was wondering if my precepting hospital was way off their rocker!

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
When I was doing my capstone in L and D, yes it was tablet crushed and placed lady partslly posterior to cervix along with pit simultaneously.!

I've never heard of that before, and it goes against AWHONN and ACOG guidelines and recommendations

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Specializes in Labor and Delivery.

Thank you for the heads up Klone! You are most certainly my most trusted resource for all things CO and OB :D

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Specializes in Family NP, OB Nursing.

I can't imagine doing both Cytotec AND pit!! Maybe, for a demise...maybe, but why take that risk! We didn't even use cervidil and pit together.

And I second the question about placing crushed cytotec. The few times I placed cytotec pills lady partslly were difficult enough. The pill sticks to your glove and doesn't like to come off. I can't imagine placing that tiny bit of crushed powder...

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Thank you for the heads up Klone! You are most certainly my most trusted resource for all things CO and OB :D

I can't tell if you're being ironic. I promise, I'm no expert on either subject!

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Specializes in Labor and Delivery.
I can't tell if you're being ironic. I promise, I'm no expert on either subject!

I was being sincere.

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