Cytotec

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Generally, when I have a cytotec induction, things go pretty smoothly. Last night, however, was a different story. Coming on at 7 pm, I learned in report that my pt was due for her third dose. The day RN told me she was difficult to monitor because the TOCO kept flipping over, there just wasn't a good spot to pick up the contractions, etc. etc. So despite the fact that the EFM had not recorded contractions for at least 30 min or so, she proceeded to insert the third dose. Pt was 3/90/-1 (from closed, thick, and high at 3 pm)

Personally, I would not have felt comfortable putting Cytotec in a pt when I could not determine her contraction pattern. Anyway, she put the Cytotec in about 1920. At 1940, I was palpating moderate to strong contractions q 2 min. And easily got the TOCO to record, I might add.

Needless to say, pt was really uncomfortable, c/o pain rated 10, and still at 3 cm at 9 pm. I was just hoping she could hurry and get to 4 so we could get her some relief through an epidural. At 9:30, she c/o feeling something leaking. SROM with clear fluid.

At 10:10, her husband called out that she needed the nurse. Pt states "I feel fluid coming out and like the baby is trying to come out. SVE. Sure enough she is complete. As we make a mad dash to set up the delivery table and a stabilette and page all the right people (she was a midwife pt comanaged by the MD because of PIH) Mom was coaching opt to breathe through contractions. At 10:22, MD was in, instructed pt to start pushing. At 10:24, delivery of viable, 4 lb 12 oz, 36 wk baby girl. (She was induced for preeclampsia)

The midwife walked in about 5 min later. She had actually called back after we called her, to ask wasn't she just 3 cm?

Needless to say, I was not very happy with the day shift nurse, at all. IMO, she did not perform an adequate assessment before placing the Cytotec. I went back and checked her charting. She charted that contractions were moderate, and irregular. ??? They weren't even recording!!!

So, anyway, here's an example of how Cytotec and hyperstim can blow out a kid in just a couple hours (3 to complete in an hour and 10 min).

Btw, it's not just Cytotec. We had a pt last week who hyperstimed on Cervidil. It was pulled. She went from 4 to complete in 45 min. Luckily, the doc was in house for that one.

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Specializes in Nephrology, Cardiology, ER, ICU.

Okay - I'm just a dumb ER nurse, but why not just let the patients labor naturally?? My kids are older (23 and 18) and we just did it naturally, no meds, nada - my kids were both very healthy.

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Originally posted by traumaRUs

Okay - I'm just a dumb ER nurse, but why not just let the patients labor naturally?? My kids are older (23 and 18) and we just did it naturally, no meds, nada - my kids were both very healthy.

She stated that this was an induction for PIH, the patient had preeclampsia.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Ya'll best get a GOOD cytotec/cervidil policy going on ASAP and STICK to it.....

you are very lucky baby and mom are ok......shutter to think of the possiblilities......hyperstim-related rupture, fetal hypoxia...etc. This was negligence of a high order. I would be in my manager's office if your policy is NOT clear when to HOLD or D/C these interventions when it's indicated....or get these people some remedial training yesterday.

can ya spell D a n g e r o u s ?????:(

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Specializes in ER.

If she was palpating the contractions, and documented her findings, then an accurate assessment was done, even if the toco wasn't picking up. Once the SROM occurs we usually redo the lady partsl exam because of the likelyhood that significant changes have taken place. Of course you didn't have time...if I was the Mom I would have been very happy that it was over with quickly.

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Originally posted by canoehead

If she was palpating the contractions, and documented her findings,

That's just it. I don't think she was. If you looked further back on the strip, the pt had tripling and quadrupling (is that a word?) contractions, then 3-4 minutes later, would have another. Then the toco wouldn't record for awhile. She never documented the contractions as anything but irregular.

We do have a Cytotec policy. Unfortunately, in this instance, it wasn't followed. Instead of waiting to accurately assess ctx, I think she just assumed they were still irregular. Because when I asked her if she adjusted the toco, she said yes, that the contractions were "here and there". Although it still wasn't recording when I went in for my first assessment about 10 min after she placed it. All I had to do was stand there and watch Mom to see she was contracting every couple minutes. :o

And traumaRus, we do try to let pts labor naturally, but this pt had preeclampsia, uncontrolled by Mag sulfate. Her condition was worsening and delivery was the only tx.

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Specializes in OB.

I am a nursing student, and I just did a research paper on cytotec last semester for pharmacology class. In the research I found they said that cytotec is not being used anymore because of the effects that you stated. Fast uncontrolled labor, and the dangers to mom and baby.

I thought it was interesting to find out that it is still being used. Do a lot of facilities still use cytotec or have most of them changed to cirvadil?

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This is the main reason that I hate using Cytotec. It may be "great" for "ripening" a cervix, but once you put it in you can't take it back. You can always pull a Cervidil or shut off the Pit, but Cytotec is a lost cause. By the way what dosage of Cytotec was prescribed? No wonder the package insert says 'not to be taken by pregnant patients'

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Specializes in NICU,MB,Lact.Consultant, L/D.

Just one little question...we have to document Bishops score before inserting cytotec and if more than 10 ctx in an hour they do not get another dose.

Do you use Bishops score?

As for the monitor...sometimes bellybands work better esp with a folded up washcloth between toco and bellyband to provide some extra pressure

Cheryll

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Yes, we have the Bishop scoring, but no one ever documents it being done... even in the person is closed, thick&firn, and sky high.. guess what... they still get the Cytotec! You know I wonder why they even come up with things if docs are just going to totally override it each and every time they just want to get a patient delivered!!! Anyone else wonder this? :confused:

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Originally posted by AndreaRN23

Yes, we have the Bishop scoring, but no one ever documents it being done... even in the person is closed, thick&firn, and sky high.. guess what... they still get the Cytotec!

If they need to be induced for a medical reason, this is one of the indications for the use of Cytotec, to ripen the cervix. You wouldn't want to start Pit on an unripe cervix.

The docs here are required to fill out a Bishop's score, that also lists the reason for induction, on all induced pts.

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Originally posted by rpbear

In the research I found they said that cytotec is not being used anymore because of the effects that you stated. Fast uncontrolled labor, and the dangers to mom and baby.

I thought it was interesting to find out that it is still being used. Do a lot of facilities still use cytotec or have most of them changed to cirvadil?

It is still being used, alot. It ismore cost effective than Cervidil, and when used following a protocol, generally has the same effect as Cervidil. Did I mention our Cervidil induction that went from 3-10 cm in 45 min, after the Cervidil was pulled? Neither drug is harmless.

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