Cytotec for Inductions - page 2

My hospital will soon be using Cytotec for labor induction. I wondered if anyone out there has used this drug for inductions before, and what your opinions were on that. The literature seems to... Read More

  1. by   L&D.RN
    We give Cytotec orally for induction purposes, never vaginally. We give 100mcg q 4-6 hours. Contraindications are grandmultip, prior uterine surgery, concomitant use of pit, non-vertex (duh), non-reassuring fetal status, presence of regular painful contraction q 5min or closer and/or patient refusal. They do have to read a handout first and sign a consent.

    It does make rapid cervical change when it kicks in, but most of the time it ripens very well and works great. I've never had to give more than the second dose and they are in labor. Some of our docs won't use it, but one group swears by it.
  2. by   ceecel.dee
    We, too, were nervous when the docs initially started ordering Cytotec, but it has actually worked very well for us.
    Are you nurses inserting it routinely? Some of our nurses do, and some refuse, depending on comfort level.
  3. by   PegRNBSN
    The OB chief of staff and our perinatologist both refused to allow Cytotec for use in live birth inductions in our hospital. They told us that studies of the literature show only cost as a proven benefit with potentially harmful side effects.
    We are sticking with Cervidil.
  4. by   BETSRN
    I am against any nurse inserting Miso or Cervidil. The practitioner should be the one inserting it as they have the ultimate responsibility for its use. The patient shoudl be evaluated by the doc or CNM prior to the insertion. We take enought responsibiltiy without adding those two to our list!
  5. by   lovewhatIdo
    Our facility uses cytotec and it is a mixed bag of reactions from the nursing staff. It is very unpredictable and a woman can go from no cervical change to very rapid dilation/active labor. I myself have not had to give turb for hyperstim yet (knock on wood!) Most everyone here loves it for pp hemorrhage and uses it if pit doesn't do the trick, or if very heavy bleed.
    Our cytotec orders- 25-50 mcg q3-4h in post fornix (administered by physician or RN). Hold medication if contractions are >3 in a10 minute period lasting 20 minutes.
    We are to monitor at minimum 1-2 hours after each dose. Some Docs because of the potential for harm order cont. monitoring. (Smart Doc's!)

    PP-give 100-200mcg pr for hemorrhage.
  6. by   NewL/DRN
    The unit I work on uses both cervadil and cytotec. Cervadil is used mainly for regular term/post-term inductions and cytotec for cases of IUFD. We have orders to use up to 400mcg vag q 3-4 hours in cases of IUFD. Talk about scary! Even though we are not having to worry about the fetus, uterine rupture is a possibility. We also use 800mcg rectally for PP bleeding, I find this just as messy as hemabate. I do not like using this drug. But like everyone thing else in L/D I find lots of contradictions between units and literature.
  7. by   NewL/DRN
    Nurses do routinely insert cytotec/cervadil on my unit. Only one nurse has refused to insert cytotec and she was written up. Docs order it and go to bed. (I work night-shift). The most I have been told to give is 200mcg vag q 4 hours for fetal demise.
  8. by   winewinn
    I'm not a nurse, but wanted to add my point of view from a patient's perspective! I didn't have a very good experience with Cytotec. I was administered a half tablet at 36 weeks due to stillbirth. I was already about 3-4 cm dilated. Very painful, on-top-of-another contractions and it probably hyperstimulated me. The nurse even overrode my dose of morphine several times but to no avail for any relief. Pain finally stopped when my baby pretty much shot out of me!

    Just my 2 cents, but I'd never touch the stuff again.

  9. by   ImaEMT
    I also wanted to add a personal perspective. I had Cytotec with both my deliveries. The first delivery, I had 3 doses before cervical ripening occured, and ended up with a very painful pitocin induction afterwards. When my Dr ( different than with my 1st baby) suggested Cytotec for my 2nd delivery, I read all I could find about it. The literature SCARED me to death! I initially refused any Cytotec at all, but since I was 41 1/2 weeks with no cervical change at all, I finally elected to a2 1/4 doses. Well...that little dose threw me into hyperstimulation and though my delivery was 3 hours from time of SROM to was by far more painful and intense than the pit induction had been. The force, frequency and length of my contractions even made my MD worried, and he wasn't ashamed to admit it.

    I ultimately ended up with a *small* PP hemorrage and a subsequent retained placenta that had to be manually removed ( not from the Cytotec, I'm sure)

    I highly doubt that I will allow Cytotec if I have a 3rd pregnancy. The risks of going to 42 weeks seem less in light of what Cytotec can cause.

    Don't know how I'll feel about it when I work in OB. Our docs love it at the hospital, and thankfully, there haven't been any major problems from it that I know.

  10. by   rdhdnrs
    We use Cytotec quite a bit in the university setting where I work. I think it works well for cervical ripening. We use 25mcg q 4 hr vaginally or orally. I have only seen one case of hyperstimulation with this dose.
    For IUFD we use up to 400mcg q 4-6 hr. It always works for us.
    The only drawback of Cytotec is it is not reversible. Terb doesn't work that well with it.
    I think Cytotec has gotten a bad rap.
    We don't use Cervidil; Cervidil is about $400 a dose; Cytotec is 40 cents!!
  11. by   L&D_RN_OH
    Originally posted by rdhdnrs
    We use Cytotec quite a bit in the university setting where I work. I think it works well for cervical ripening. We use 25mcg q 4 hr vaginally or orally. I have only seen one case of hyperstimulation with this dose.

    I think Cytotec has gotten a bad rap.
    We don't use Cervidil; Cervidil is about $400 a dose; Cytotec is 40 cents!!
    I have seen 2 cases, and both of those I blame more on nursing care than the Cytotec. In all reality, these pts should not have been dosed with Cytotec a second or third time, based on their contraction pattern. I have actually seen hyperstim more often with Cervidil, and while you can pull it out, it seems the damage is already done. I've seen more kidsblown out with Cervidil than Cytotec. JME.

    I think the cost factor, and the monitoring requirements are big considerations when determining when ripening agent eill be used. We require cont. EFM for Cervidil, but not for Cytotec. They are monitored for 2 hours after insertion, which allows the pt more freedom of movement.
  12. by   babyrex33
    When thinking of Cytotec, only one word comes to mind......HORROR!!!! This is one of the most unpredictable induction medications on the market. Pay very close attention to the consent your patient must sign prior to insertion.......THE MANUFACTURER specifically states this is not a medication to be used in pregnant woman. My negative experiences with this drug have greatly outweighed the positives!!! Most nurses in one hospital I worked at refused to place the Cytotec due to liability issues. You are placing a medication that specifically states it should not be used when pregnant. The docs would come in to place Cytotec if they wanted it used.

    Good Luck!!!
  13. by   Supersleuth
    We used this drug like it was going out of style at the last place I worked. I think it works so much better than cervidil too. All night long on cervidil and then in the morning Pit lead to more sections in my experience. I think that it really depends on the dose. The university hospital I was at used 50 mcg and it worked very well. It is also unbelieveable at stopping PPH--just make sure the Pit is off if you give a ton of Miso!
    At the next place I was at they used only 25 mcg q4h and most of the women need at least 2 doses to ripen really well. I RARELY saw hyperstim.
    My own personal experience with Misoprostol was very much the same as I have in practice--41 4/7 weeks, no CTX. Cervidil all night, Pit all the next day--NOTHING. Miso, 2 doses the next night and the next am I was 3 cms with little to no cramping to speak of. Maybe I have been lucky all these years-but in 6 years I haven't seen any cut and dried "It must have been the cytotec" reasons for bad outcomes.