Cytotec for IUFD

klone, MSN, RN · May 2, 2014

The only time I've heard of high dose cytotec used for induction is with second trimester IUFDs, when 600-800mcg is used. I agree with you that even though you no longer have to worry about fetal tolerance to labor, you still have the concern about uterine rupture with high doses when the uterus is that large.

TexRN, BSN, RN · May 2, 2014

I was under the impression that cytotec is dangerous and not meant for induction purposes period. There have been many deaths associated with cytotec.

The Freedom to Birthâ€"The Use of Cytotec to Induce Labor: A Non-Evidence-Based Intervention

klone, MSN, RN · May 2, 2014

Cytotec can be dangerous if used inappropriately. So can Pitocin. So can MgSO4, as well as myriad other medications used in labor.

The judicious use of Cytotec can be a safe and effective way to induce labor, especially in a woman who has a low Bishop score or otherwise has a completely unripe cervix.

TexRN, BSN, RN · May 2, 2014

Cytotec can be dangerous if used inappropriately. So can Pitocin. So can MgSO4, as well as myriad other medications used in labor.
The judicious use of Cytotec can be a safe and effective way to induce labor, especially in a woman who has a low Bishop score or otherwise has a completely unripe cervix.

Isn't it consedered to be used inappropriately when that is not what the drug is meant to be used for in the first place?

Cytotec (Misoprostol) Drug Information: Description, User Reviews, Drug Side Effects, Interactions - Prescribing Information at RxList

klone, MSN, RN · May 3, 2014

Drugs are used all the time off-label.

For instance, Reglan and Motilium (domperidone) used as galactogogues.

No, it's not considered inappropriate. http://www.m.webmd.com/a-to-z-guides/features/off-label-drug-use-what-you-need-to-know

BuckyBadgerRN, ASN, RN · May 3, 2014

When I was expecting babies (WAS, shop is closed now!) my MD knew my adament wishes were that under no circumstances was he to even think about suggesting Cytotec for induction of labor. A little education CAN be a good thing =)

queenanneslace, ADN, MSN, APRN, CNM · May 3, 2014

Eek. There are a few local practices that will use cytotec 800mcg for first trimester missed ABs and even early second trimester losses (before 20 weeks). But at term? That seems all wrong. And not safe.

queenanneslace, ADN, MSN, APRN, CNM · May 3, 2014

Am looking for a dosing guideline that comes from a reputable source (i.e.: ACOG). I've found info on misoprostol.org but am looking for further info. Any help is appreciated.

Back to your request - I like Medscape. I found this article:

http://www.medscape.com/viewarticle/712295_1

The generally accepted safe dosing for induction with misoprostol at term is:

"25 mcg of misoprostol (Cytotec) per lady parts, every 4 hours, for up to 6 doses,"

This article does not specifically address induction after IUFD, or any change in induction protocols - I don't know why this would be different. The resident may have been confusing dosage of cytotec for management for missed AB, vs induction of labor at term. Could happen.

I went up the chain and got the order changed to Pit instead.

Thanks for sticking your neck out for best practice and patient safety. Not fun to rock the boat, but good for you. Thank you. This makes me proud to be nurse.

klone, MSN, RN · May 3, 2014

http://www.misoprostol.org/File/dosage_guidelines.pdf

For a second trimester missed AB, you can do 200mcg per lady parts q 12 h. However, after 24 weeks, it's recommended that you use the same protocol for live IOLs (25mcg per vag q 6 h), except that they say you can double it after two doses if necessary.

klone, MSN, RN · May 3, 2014

Here's a study on high-dose misoprostol for mid-trimester IOLs. It was found to be more effective/faster. By "high dose" they were using 600mcg q 4 h.

High Dose lady partsl Misoprostol Versus Concentrated Oxytocin + Low Dose lady partsl Misoprostol for Mid-Trimester Labor Induction: A Randomized Trial

klone, MSN, RN · May 3, 2014

Another study found 400mcg q4h to be the optimal dose that both minimizes side effects of lower doses (retained POC) as well as side effects of higher doses. But again, these are all mid-trimester IOLs, and only up to 24 weeks. Beyond that GA, all evidence suggests you should follow the same protocol as a term IOL (i.e. 25-50mcg max at a time).

http://academicobgyn.com/2009/10/24/evidence-based-use-of-misoprostol-in-second-trimester-induction/