Cytotec for Inductions

Specialties Ob/Gyn

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My hospital will soon be using Cytotec for labor induction. I wondered if anyone out there has used this drug for inductions before, and what your opinions were on that. The literature seems to indicate that if you use a small dose and don't redose for 4 hours, that things should be fine, but I can't shake the horror stories that are in the literature as well. Any one with experience with Cytotec for inductions, please post and let me know your thoughts.

Thanks,

Steel Town RN

When thinking of Cytotec, only one word comes to mind......HORROR!!!! This is one of the most unpredictable induction medications on the market. Pay very close attention to the consent your patient must sign prior to insertion.......THE MANUFACTURER specifically states this is not a medication to be used in pregnant woman. My negative experiences with this drug have greatly outweighed the positives!!! Most nurses in one hospital I worked at refused to place the Cytotec due to liability issues. You are placing a medication that specifically states it should not be used when pregnant. The docs would come in to place Cytotec if they wanted it used.

Good Luck!!!

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We used this drug like it was going out of style at the last place I worked. I think it works so much better than cervidil too. All night long on cervidil and then in the morning Pit lead to more sections in my experience. I think that it really depends on the dose. The university hospital I was at used 50 mcg and it worked very well. It is also unbelieveable at stopping PPH--just make sure the Pit is off if you give a ton of Miso!

At the next place I was at they used only 25 mcg q4h and most of the women need at least 2 doses to ripen really well. I RARELY saw hyperstim.

My own personal experience with Misoprostol was very much the same as I have in practice--41 4/7 weeks, no CTX. Cervidil all night, Pit all the next day--NOTHING. Miso, 2 doses the next night and the next am I was 3 cms with little to no cramping to speak of. Maybe I have been lucky all these years-but in 6 years I haven't seen any cut and dried "It must have been the cytotec" reasons for bad outcomes.

Erin

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We use it, and it works well. Sometimes it really moves things along quicker than we're used to with our good ol' cervidil. It's great with a cervix that isn't ready for pit. We give 100mcg q 4-6 hours, but there are stipulations such as if they're contracting >2 in 10 min with some pain, we hold off. There is also a list of contraindications that would restrict our use in certain patients. Some of the nurses don't love it, but I like it a lot better than cervidil, and it's much easier to administer!

This is a really high dose. The high doses are what is associated with poor outcomes- I believe no more than 50 mcg Q 4 H is what is recommended so it may be prudent to look into that. Most of our docs use cytotec, we only have one who uses cervidil. We are about 50/50 who goes into labor just from the cytotec and those who still need pit.

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Specializes in Ante-Intra-Postpartum, Post Gyne.
Thanks for responding. Can you elaborate on what the contraindications are? The only ones I'm aware of are: low Bishop score (obviously), and having 5 or more past pregnancies. Are there more? Thanks in advance.

Ummm....pregnancy!!!!

First, in reality, using Cytotec for induction is not "off-label" at all--it is "on-label contraindicated." On the Cytotec label it is explicitly written that this drug is contraindicated for use on pregnant women. Contraindication would not be on the label unless data exist suggesting possible serious risks from such use. "On-label contraindicated" is a whole different level of risk-taking than a use that is not mentioned one way or the other on the label.

http://www.midwiferytoday.com/articles/cytotec.asp

I just did a preceptorship in L&D at a hospital that uses cytotec but they give it PO instead of lady partslly...the nurses said its ok to give it PO...but has anyone else heard if giving PO is safe and does not cause the uterine ruptures that can happen with lady partslly? (I am still skeptical)

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Ummm....pregnancy!!!!

http://www.midwiferytoday.com/articles/cytotec.asp

I just did a preceptorship in L&D at a hospital that uses cytotec but they give it PO instead of lady partslly...the nurses said its ok to give it PO...but has anyone else heard if giving PO is safe and does not cause the uterine ruptures that can happen with lady partslly? (I am still skeptical)

It is equally effective as lady partslly without the discomfort of insertion. It still causes the same adverse effects. Many OBs argue that if it is given PO it cannot be retrieved but good luck pulling 25 mcg of cytotec out of the lady parts. I think PO is a much more woman-friendly method of insertion.

Keep in mind that many drugs are used off-label in OB. Including terbutaline. There are many limitations to getting a drug approved for use in OB including the difficulty in studying the effects, the costs, and the ethical questions. There is no benefit for the manufacturers of cytotec or terbutaline to get FDA approval when the drug is cheap, already in use and proven. Although there are adverse outcomes associated with cytotec this is true of any drug and any unnecessary intervention which most cases of cytotec use are. More prudent would be limiting inductions of any type to the medically necessary.

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Specializes in Ante-Intra-Postpartum, Post Gyne.
Keep in mind that many drugs are used off-label in OB. Including terbutaline.

Where does a nurse stand legally if she is the one that administors an off-label/against label drug such as cytotec and then the pt sues when somthing goes wrong?

More prudent would be limiting inductions of any type to the medically necessary.

:yeahthat::yeah:

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Where does a nurse stand legally if she is the one that administors an off-label/against label drug such as cytotec and then the pt sues when somthing goes wrong?

I don't really know but I have been told "local practice standard" trumps everything, including medical evidence, in court. The example I was given is continuous fetal monitoring. Science says it is bad, but if I don't do it and baby dies, then in court I get nailed because "local practice standard" says that it should be done (i.e. hospital policy or all the other docs are doing it). Same with using terb or cytotec. If I use it and bad outcome but "everyone else is doing it" I may have some degree of protection. Also, whatever ACOG says about it can be helpful/harmful. But I don't know any of this for fact:) Maybe you could just hide behine "doctor's orders." I would love to see what would happened if I start refusing to administer cytotec to patients-- I can guess it would involve me and the unemployment line.

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