Cytotec and fetal monitoring

[obtech2nurse]

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)

[AprilAZRN]

How did you get a crushed tablet into to posterior fornix? We have a few drs that like the 25mcg lady partslly, most are 50mcg PO.

And never ever with pit running at the same time. Sounds like a crash waiting to happen.. yikes!

[klone, MSN, RN]

How did you get a crushed tablet into to posterior fornix?

Yeah, I still want to know how one manages that.

[rn4babies63]

We give our Cytotec either 25mcg in the posterior fornix of the lady parts or 50 mcg po. I'm also baffled as to how anyone is crushing it and placing it into the lady parts. It's difficult enough to place 1/4 tablet without having it come back out onto your glove. We don't start Pitociin until 4 hours after a Cytotec dose. We've had good success with Cytotec and our nurses place it. We have to have a reactive 30 minute tracing before placing it then do vital signs every 15 min for 1 hour. We then do hourly vitals including FHR for the next 3 hours if the patient desires to walk. After the 4th hour, the pt is then reevaluated and then we may start the process all over again.

[RNlovesherPharmD]

Yeah, I still want to know how one manages that.

To be honest, I don't know. I was only allowed to lady partsls post epidural.

I was simply asking about what I observed, and from the sound of it will never see again

[nurseynightnight]

We use cytotec for most of our inductions. 30 minute strip then they can be up and monitored 20 minutes out of every hour. we give 25 mcg lady partslly every 4 hours up to 4 doses.

[Mec_Happens]

We have an applicator to use to place the cytotec - I can't imagine trying to place it without it, much less crushed. I've never given cytotec PO.

Our policy is a reactive strip prior to placing the cytotec and then continuous monitoring (but all of our patients regardless of being induced or not) are on continuous monitoring.