Cytotec

[JenDenRN]

We have a MD that is fairly new to our area that routinely will insert 800mcg of cytotec rectally post delivery. he will do this both after delivery of a pt with either a "boggy" uterus not firmed up with pitocin or methergine or a pt that has increased risk of postpartum haemorrhage due to prolonged pitocin induction, magnesium sulfate therapy or grand multips. He claims it works much better than hemabate; which has horrible side effects!! Code brown anyone?? It seems to work very well with little side effects to the pt. anyone else out there doing this routinely?

[melmarie23, MSN, RN]

We will give cytotec (600mg) rectal or sl if pit doesn't work. We usually go pit, cytotec, methergine and then hemabate (in that order).

[klone, MSN, RN]

Yep, that's pretty standard wherever I've worked as well. We also do it in the same order as Melmarie. Is it not something you've ever heard of, JenDen? Do your other physicians not use Cytotec postpartum for PPH prevention?

[Katie71275]

Yes. I've seen the docs use about 1000mcg of Cytotec at a time. That seems pretty standard.

[JenDenRN]

The first hospital I worked at in L&D would use 1,000mcg cytotec rectally only as a last resort. It would go pitocin, methergine hemabate, then cytotec. The hospital I'm at now seems to use the cytotec even less. Until this new MD arrived.

It seems to work so much better w/ much less side effects than the methergine & hemabate. Thanks for the feedback!

[klone, MSN, RN]

We've always used Hemabate as a last resort drug, both because of the horrible GI side effects, but also because it's contraindicated in asthma patients, and so many patients nowadays have asthma or RAD.

[IrishIzCPNP, MSN, RN, APRN, NP]

Our first goto when we had an issue was a "miso-bullet". It was 1000 made into a rectal suppository. Pharmacy makes them for us and we keep them in the refrigerator. They work great!

[JenDenRN]

Our first goto when we had an issue was a "miso-bullet". It was 1000 made into a rectal suppository. Pharmacy makes them for us and we keep them in the refrigerator. They work great!

Wow!! That "miso-bullet" sounds great. It is so time consuming to open each little 100mcg tablet container & then make sure that all 8-10 get inserted. Especially when time is of the essence. I agree that the horrible GI side effects of hemabate should make it the last resort. We always prepare ourselves for a "code brown" when we have to give it.

[klone, MSN, RN]

Our Pyxis stocks Misoprostol in both 100mg and 200mg, so when we use it postpartum, we grab the 200mg and use 3-4 pills.