Cytotec for PP hemorrhage

[Conejita]

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!

[HeartsOpenWide, 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.

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]

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

[mauiiRN]

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 lady partsl or rectal administration;

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

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

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

[bhobrn76]

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

[LDR-RN]

We give it PR or PV usually for PP hemorrhage.