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Cytotec for PP hemorrhage

Posted

Specializes in Antepartum, L&D, Postpartum.

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!

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

Specializes in med/surg, ob/gyn, CM. Has 6 years experience.

Our docs give it PR.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

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

Specializes in PACU, OR.

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 vaginally! Anyone else see this, or can you clarify it for me?

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

Specializes in Community, OB, Nursery.

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 vaginally! Anyone else see this, or can you clarify it for me?

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

GHGoonette, BSN, RN

Specializes in PACU, OR.

It can given vaginally, 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 vaginally.

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

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I guess it depends on what you're using it for....giving it vaginally 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

Specializes in LTC, SICU,RNICU. Has 2 years experience.

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

Specializes in PACU, OR.

I guess it depends on what you're using it for....giving it vaginally 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 vaginally. So now I'm wondering if the gynae herself knows the correct administration routes... :confused:. Might be a good idea to start asking the midwives.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

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.

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

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.

Are you thinking of Cervadil? Cytotec does not do this, it causes contractions. Cytotec is Misoprostol, the same thing use in early pregnancy for medical abortions.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

Cytotec works the same way as Cervidil. They're both prostaglandins, and ripen the cervix. Usually they will also cause UCs as well, and sometimes follow up Pit is not necessary.

If a woman is closed, thick and high and needs to be induced, the usual protocol is to use a few doses of Cytotec to ripen the cervix before starting her on Pit. Pitting an unripe cervix usually doesn't work.

Many facilities have gone to Cytotec instead of Cervidil, because it's MUCH cheaper, and just as (if not possibly more) effective than Cervidil.

For IOL, we usually use 25mcg PV q4h PRN, or 50-100 mcg PO q4h. What's nice about it is that it CAN be used PO, which is good for women who have PROM

Edited by klone

We use misoprostol frequently in our unit for PPH. Here is info I have obtained from an obstetrical research program we use:

Sublingual administration has the most rapid onset and highest peak;

Peak concentration is achieved faster with oral and sublingual administration than with vaginal or rectal administration;

The initial increase in tonus is more pronounced after oral than after vaginal administration;

Rectal and vaginal routes have a slower but longer effect than oral and sublingual.

So, you can give Cytotec PO, SL, PR, or vaginally. Sometimes our docs give 400mcg SL and 400mcg PR simultaneously.

bhobrn76

Specializes in OB, ER, med/surg. Has 7 years experience.

Our OB's use Cytotec 25mg intravag for induction, 400-600mg intravag for missed abortions, and 800mg PR for postpartum hemorrhage.

LDR-RN

Has 5 years experience.

We give it PR or PV usually for PP hemorrhage.