Cytotec and FHR...what would you do

SmilingBluEyes · Jun 25, 2015

NO I would not, at least not without checking with the MD. But, is it a prolonged accel or a sustained FHR above 160? That I cannot see without a strip. But if that is your baseline, NOPE I would not do it. You can't turn cytotec "off" like you can pitocin.

tweety1023 · Jun 26, 2015

Well an elevated heart rate for over 10 minutes is technically considered a change in baseline, no longer an acceleration. No I would not give cytotec with a baseline of 160-190

Elvish, BSN, DNP, RN, NP · Jun 26, 2015

We've stopped giving Cytotec at all for pregnancies with a live fetus. No way I'd give it with a HR that high.

klone, MSN, RN · Jun 26, 2015

We've stopped giving Cytotec at all for pregnancies with a live fetus. No way I'd give it with a HR that high.

How do you handle inductions for someone who's closed, thick and high? Do you just use cervidil?

Elvish, BSN, DNP, RN, NP · Jun 27, 2015

How do you handle inductions for someone who's closed, thick and high? Do you just use cervidil?

Foley bulb and sleep, then pit in the AM. Very rare that we do anything else.

klone, MSN, RN · Jun 27, 2015

Foley bulb and sleep, then pit in the AM. Very rare that we do anything else.

How do you do a foley if she's closed and thick?

NurseNora, BSN, RN · Jun 28, 2015

What's the patients temperature? What's the activity level of the fetus?if it's between 9pm and 1am, it's probably baby's aerobics time and it'll come back down when baby quiets. I still wouldn't give it until it got back to baseline, but those are two important parts of your assessment to tell the doctor when you call to say you're holding the Cytotec.

klone, MSN, RN · Jun 29, 2015

If the FHR is 190 for 30 minutes, that *is* the baseline.

IDeliverRN · Jul 2, 2015

I agree with all of you, that was the baseline. The doctor was saying it was not the baseline, they were just accels. Temp was fine. Baby was active. Variability was good. I held it until the hr came down to 160. My charge nurse agreed to holding it as well. After I explained why I wasn't comfortable giving it, the doc just said ok. He's not too pushy which I respect.

Red Kryptonite · Jul 2, 2015

Maybe if she's closed and thick you should be leaving her alone?! Radical idea, I know.

As to cytotec, the fact that anyone still risks mothers' and babies' lives with that is disgusting.

klone, MSN, RN · Jul 2, 2015

Maybe if she's closed and thick you should be leaving her alone?! Radical idea, I know.

There are times when a closed, thick cervix still needs to be induced (severe pre-eclampsia or HELLP syndrome, IUGR with reverse end diastolic flow, as a few examples).

Kryptonite, all inductions are not of the debil. Sometimes they really ARE necessary. Sometimes they are life-saving to moms and/or babies. Once in a great while, science really does have a place in the natural process. Sometimes one knows "just enough to be dangerous" and doesn't know enough to know the full implications of being 100% hands-off, all the time. I get it. I was there once. I talked about "medwives" and "gOBlins".

And cytotec induction on an unripe cervix is still a lot less risky than a cesarean, which is usually the alternative when trying to deliver a baby over an unripe cervix.