Cytotec for PP hemorrhage

[Conejita, BSN]

Dearest L&D nurses,

Just wondering if anyone knows the best route for Cytotec (misoprostol) being used in PP hemorrhage?

Our docs/midwives order it given PR, PO, and sublingual/buccal...all in various doses from 200mcg-800mcg. I have mostly read about it being given PR for PP hemorrhage and am wondering if this is supposed to be the fastest-acting/best way to give it? What do your docs/midwives do the most? Is this a provider preference kind of thing or is there some research behind it?

Thanks for any input!

[rn/writer, RN]

I have seen our docs give it PR only (usually 800 mcg). The absorption rate is as quick as (if not quicker than) oral, and you don't have to worry about n/v. Some of these women are quite shocky and feel queasy.

[katieusa]

Our docs give it PR.

[Elvish, BSN, DNP, RN, NP]

For PP hemorrhage, we (meaning the OBs; RNs can't place cytotec per the state BON) place cytotec PR. Usual dose is 800-1000mcg.

[GHGoonette, BSN, RN]

I'm very interested to read these responses; not working in PP I'm not familiar with Cytotec, but we do keep it in PACU. I've seen gynaes give it lady partslly! Anyone else see this, or can you clarify it for me?

[krenee]

I work in PP and I haven't seen it used so this is interesting. Granted I've only been in PP a year and haven't had a patient hemorrhage (knock wood), but AFAIK we just use pit & methergine. Can anyone elaborate on why cytotec is used instead?

[Elvish, BSN, DNP, RN, NP]

I'm very interested to read these responses; not working in PP I'm not familiar with Cytotec, but we do keep it in PACU. I've seen gynaes give it lady partslly! Anyone else see this, or can you clarify it for me?

It can given lady partslly, but in my neck of the woods that's mostly for inductions.

[GHGoonette, BSN, RN]

It can given lady partslly, but in my neck of the woods that's mostly for inductions.

Strange, I don't see it used frequently, but on the couple of occasions when it's been ordered, the gynae has inserted it herself-post operatively (if I remember rightly post evacuation.) And she did insert it lady partslly.

Thanks for the info, I'll follow that up with her when I see her again.

[Elvish, BSN, DNP, RN, NP]

I guess it depends on what you're using it for....giving it lady partslly for a postpartum hemorrhage doesn't really make a lot of sense (at least not to me). What do your gynes use it for??

[hcox1975, BSN, RN]

I had cytotec when I was inducted with my last child. I was told that it would soften and dialate my cervix. To me, it was the best way to be inducted. It was quick and effective. In the past I have been inducted using only pitocin and it was the worst contractions ever. With the cytotec, it worked so well that I didn't have to have pitocin.

[GHGoonette, BSN, RN]

I guess it depends on what you're using it for....giving it lady partslly for a postpartum hemorrhage doesn't really make a lot of sense (at least not to me). What do your gynes use it for??

Like I said, it was post-evac, or D&C; the patient was bleeding quite heavily and I assumed it was to control bleeding, but according to what was posted, the route she used is not the correct one. That's what I find so interesting.

I know they give it to induce abortion, so I can see it's quite logical to use as a labour induction agent, which as you've pointed out, is administered lady partslly. So now I'm wondering if the gynae herself knows the correct administration routes... . Might be a good idea to start asking the midwives.

[klone, MSN, RN]

For PPH, we also use 800mcg PR. Usually that's in conjunction with Pit, methergine, and sometimes Hemabate (although most care providers who have some experience under their belts try to use Hemabate as a last resort).

Occasionally I've had doctors order a med PO q6h for 4 doses, as well (for cases of PPH in which they're concerned about continued uterine atony), but I don't remember if it's Cytotec or Methergine.