Cytotec Policy where I work:

[SmilingBluEyes]

Forgive me for posting this publically, but I simply cannot remember who asked me for our Cytotec Ripening/Induction Policy a while back, so for whomever is curious or needs it, here it is:

CYTOTEC ORDERS: (the following steps must all be accomplished before and during the process)

*Admit to Women's Services

*Indication for ripening/induction:___________________

*Perform 30 minute baseline non-stress test. Patient to have an empty bladder.

*H and H on admission

*Initiate OB Admission Orders

*Saline lock or IV of _____________ @________ml/hr

*Cytotec 25 micrograms (prepared by Pharmacy) must be administered per posterior fornix of cervix. Terbutaline Sulfate to be readily available for SC injection PRN.

*May repeat Cytotec 25 micrograms Q3 hours to a maximum of 75 micrograms as indicated.

* Fetal monitoring x1 hour after insertion, then for 15 minutes every hour thereafter.

* Vital Signs Q 30 minutes x 1st hour, then Q hour.

*No more than 2 variable decelerations exceeding 60 seconds' duration and decreasing 60 BPM from baseline within the previous 30 minutes prior to

cytotec insertion.

* Notify provider of hyperstimulation with fetal deceleration, bradycardia, or tachycardia. Initiate preventive measures (e.g. hydration, position changes, oxygen at 10L/mask).

* May give Terbutaline 0.25 mg sub-q x 1 dose for symptomatic uterine hyperstimulation.

*Patient may eat and ambulate if fetal and maternal status is reassuring and patient is not in active labor.

This order comes from the physicians' offices, filled out prior to the Induction/Ripening.

HTH.

[rigbyk]

I thought Cytotec was that stuff that is known to have all those awful/potentially fatal side effects and was not certified/legalized/researched for use in laboring women?

[SmilingBluEyes]

not any longer true. there is more current literature and study on this drug being used as a cerivical ripening agent. it is legal and is considered relatively safe, when used judiciously and in the right conditions. if you are interested, please do some research regarding cytotec induction in recent years or discuss it with professionals you know who are using it.

please note, i did *not* start this thread to debate the safety, or lack of it, using cytotec for cervical ripening/induction. it was to help the member(s) asking for various hospital policies regarding its use. i understand cytotec use has been controversial over the years, but this is not the thread for this discussion. feel free to peruse the archives/do a search for past discussions about cytotec for your information/education. thank you for understanding.

[rigbyk]

Thank you for the more current info! :-) I apologize, I did not mean to spark controversy.

[tdr61]

The facility I'm currently at also has it specifically in their policy that cytotec can not be used on any woman who has had more than 4 pregnancies. Out of curiosity, does anyone use cytotec for postpartum hemorrhage? If so, what dose and route do you use?

[SmilingBluEyes]

Yes we use cytotec for PP hemorrhage, 100micrograms, per rectum.

[Altalorraine]

The facility I'm currently at also has it specifically in their policy that cytotec can not be used on any woman who has had more than 4 pregnancies. Out of curiosity, does anyone use cytotec for postpartum hemorrhage? If so, what dose and route do you use?

We use Cytotec 400-800 mcg per rectum for postpartum hemorrhage.

For cervical ripening we use 25 mcg, applied to the cervix. It's contraindicated in women who've had a previous cesarean section.

Altalorraine

[tdr61]

Thanks Deb and Altalorraine for the replies. I've seen it used from 100mcg to 1000mcg per rectum, although in my travels I've found that not many hospitals are using it yet. Personally, I think it works great with fewer side effects of methergine and/or hemabate.

Ten

[SmilingBluEyes]

the only nasty effect I have seen is diarrhea and LOTS OF IT in some. But no threat of B/P effects w/cytotec. It shuts down hemorrhages COLD most of the time......gotta love it.

[SmilingBluEyes]

Yep up to 1000mcg is used......i have seen it for s/p retained placantal fragments and bleeding. it worked GREAT.

[NurseNora, BSN, RN]

We use 1000mcg per rectum for PPH and it works very quickly. I've never had a "Code Brown" with the cytotec as I have with the Hemabate.