cytotec

We use cytotec for cervical ripening. Our protocol is 25 mcg up high basically behind the cervix, q4 up to to 75 mcg, or until they are "rupturable". We then start pit 4 hrs after the last dose. With primips it doesnt usually kick them into labor, but when we have a multip come in for "cervical ripening" we prepare for a night shift delivery LOL.

We do continuous monitoring once the cytotec is placed.

I despise placing cytotec because it seems most of the time, the cervix is in their tonsils and we cant use gel so it is just so uncomfortable for them.

I see some hyperstims here and there. The thing I really dont like about cytotec is sometimes it kicks people into this irritable contraction pattern where they're contracting every 2 min but maybe they're not super strong etc. Then we have to make a decision as to whether or not to give another dose. I usually refuse and ask for low dose pitocin instead. Cytotec makes me nervous.

what docs here usually do is the night before they have the pt come to the hospital and we insert cytotec or cervidil lady partslly(they are both used about the same here), and with cytotec we start out with one dose of 25 mcg, then after four hours (as long as there is no hyperstim and the baby is tolerating it well) we do a 50 mcg dose. Usually by 0700 the next morning we start the pitocin. I have seen quite a few precips off of cytotec though.

Hello! We are re-doing/updating our protocols and since I'm on that committee ( lucky me!) I was wondering if anyone has a copy of their actual protocol they can send me? I looked up some info on the web, just wondering where everyone got their info for the protocol ( ex: how long and how often the pt must be monitored) etc...thanks for the help! Looking for up-to-date info please! And if you have any sites that are wonderful for doing protocols please send me the website also! THANKS! I really appreciate it!

wow. 50 of cytotec? we start out with 25, and rarely if almost never do we have hyperstim! and never ever do the docs send them home afterward, they stay with us, being monitored closely till delivery. I guess I will take my small town rural area with only 4 OBGYNS in practice! (easier to control them- lol :)

We used to use Cytotec 50 mcg p.o. Q 2-3 hrs. Had a lot of precips. It was too much!

They changed the protocol to 25 mcg p.o. or intralady partslly (mostly use po) Q 6 hrs. Now, it helps ripen, but usually Pit is needed the next morning. The docs don't use it as much now that they can't blast the babies out with it.

we 250 deliveries a month and use it ofen. i think of it as a kinder gentler induction. i feel we can get them farther into labor before they percieve it as horible. faster deliveries sometimes ,but isnt delivery the goal? it is great for 2nd tri demises,usually they del after the 3rd dose.

Currently in my small hospital(14-16 del/month) we do not use it. It is a big no-no with our insurance.(I had fun telling the MD the first time) The only time it is used is with fetal demises

I would never work in a hospital that used Cytotec for labor induction...its not just off label use, it is AGAINST label use. I am disgusted that it is still being used today in some parts of the country.

First, in reality, using Cytotec for induction is not "off-label" at all--it is "on-label contraindicated." On the Cytotec label it is explicitly written that this drug is contraindicated for use on pregnant women. Contraindication would not be on the label unless data exist suggesting possible serious risks from such use. "On-label contraindicated" is a whole different level of risk-taking than a use that is not mentioned one way or the other on the label.

http://www.midwiferytoday.com/articles/cytotec.asp

Cytotec has been banned in my neck of the woods for many years for use of labor induction. We only use it on IUFD's and PP bleeds.

Does AWHONN have a position statement on the qualifications of nurses caring for in-patient high-risk ante-partum patients?

If AWHONN states that successful completion of a basic fetal monitoring course is necessary for nurses caring for these patients, then there is a national standard that your hospital had better be following. Please explore this issue and discuss it with your manager and the hospital risk manager.

If there were to be an untoward event related to fetal monitoring, a plaintiff's attorney would hang any hospital that was not following national standards for staffing and qualifications.

Good luck on this very important issue!