Cytotec

[L&D_RN_OH]

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.

[gypsyatheart]

Originally posted by AndreaRN23

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'

I haven't read all the posts, so this may have already been addressed, but the reason Cytotec has the pregnancy warning is that it was originally used and approved to treat ulcers in GI patients. They found,early in the trials that when pregnant women took this drug, in early pregnancy, they were miscarrying. Hence the warning. My understanding is that the FDA is or will be issuing approval as use as a ripening/induction agent.

We use Cytotec like it's water where I work. We do have very strict protocols in place, but I can tell you, classic Cytotec is 1st dose, usually not much happens, 2nd dose mom can start having ctxs one on top of another and the weird thing is, sometimes they aren't even aware of them. That is why it is crucial to have proper monitoring and true documentation of uterine activity. And Cytotec does work fast, if not in 2 doses usually the 3rd, and women can go from some small amt of cervical dilitation to complete in a VERY short time! That last hour of cytotec labor is intense!

All I can say is if you are using Cytotec, always have your strip/documentation accurate, always do an SVE and have at least 30 min recorded activity before placing the next dose, and for sure, have your room set up for delivery, as it usually happens fast! It is a trip to watch those ladies boomong out u/c's, practically 1, maybe 2 min apart! With this type of induction, be prepared! If labor isn't successful w/3 doses of Cytotec it's probably not gonna happen and another course should be considered.

[L&D_RN_OH]

Originally posted by Kiekuh

I am wondering if our OB's EVER even take that into consideration? Reading that, I bet at least 60-70% of our Cytotec inductions would have a score of 7 or below....

Thanks for the info!!

That's the point though. You can use Cytotec or Cervidil with an unripe cervix. You should not use Pitocin. I think the Bishop's score is used more for what type of induction agent will be used, more than whether it should occur. And a medical indication for induction always overrules the Bishop's score. We're speaking merely of elective inductions.

[mark_LD_RN]

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! 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?

closed,thick,firm,posterior,and sky high = bishop score 0

and they would get it:)

myself I am comfortable with cytotec. but still believe we should only induce for medical necessity not social inductions:)

[legsmalone, RN]

Originally posted by mark_LD_RN

but still believe we should only induce for medical necessity not social inductions:)

My place finally came up with a diagnosis to put on our induction and c section print outs for these social inductions : TOT

Tired of toting.

[luv l&d]

At our place, 3 cm's means no more cytotec.Thats it, they are done. Also with true pih'ers and pre'eclamptics and hellpers they do tend to blast ( like the body knows the way to get cured is to deliver)

[lynn27]

I really don't like cytotec for starting labor or cervical ripening--very unpredictable. With some patients, it doesn't seem to do a thing and with others, it can blow the baby out in record time. I've also seen a case where the patient was hyperstimming 6 hours after a dose and ended up getting terbutaline (was not hyperstimming the whole six hours, just all of a sudden...after shift change of course). I have also had cervidil send a patient into labor quickly but atleast I can pull the string! But, after the baby is born, I LOVE cytotec for pp hemorrhage! Definitely a love/hate relationship with that medication.

[BETSRN]

At my institution, MD's and CNM's can place Miso but they can split their own pills. We have pill splitters for that. We are also very conservative in our use of Miso, beacuse of it's erratic actions. We all much prefer Cervidil.