What do you think about the use of Cytotec?

SmilingBluEyes · Jul 29, 2004

cytotec is as unpredictable as it gets in antepartum use. In some, it does NOTHING; others causes hyperstim. that even Brethine does not help. I don't like using it much as a cervical ripener, but it's done all the time cause it is CHEAP and EASY to use. We monitor the mom/baby for two hours after placement and if all is well, they get up and walk. We place cytotec every 3 hours times 3 unless they contract every 5 minutes or less or the fetal heart rates are not reassuring. Then, typically in the morning, we start pitocin after the requisite 3 doses, if no labor pattern is established.

Now for PP hemorrhage, there is no better drug......I LOVE using it for PP hemorrhage.

txspadequeenRN, BSN, RN · Jul 29, 2004

I had cytotec with my last labor. I was on the L&D floor and they place one in you every 4 hours I believe. Got one a 8p, 12mn,and 4 a, they did tell me I would need multiple doses. I was not monitored on the monitor and they were not checking my dilation that botherd me since this was my 5th baby (meaning I could have this baby before they could get their gloves on). I said this crap dont work however around 6 am I ate those words. I was having pretty good contractions but they really progressed and at 7:45 I called the nurse back in and said i think my water broke which it partially did. She checked me and I was a 8 and a half. My doctor came in and finished breaking my water at 7:54, guess what I had her before they could get all their gear on . A healthy baby girl at 7:56 Am . So yes this worked well for me, I liked it much better that the pit.

nrsnan_1 · Jul 29, 2004

We jokingly call it cytoblast. When it works, it works with gusto. Scary stuff but the docs seem to love it.

SmilingBluEyes · Jul 29, 2004

sad thing, in the face of the severe fetal distress I have seen with cytotec use, I would not joke about it. The half life is much longer than pit and it's much more dangerous in my opinion. Unlike cervidil you can't pull it , either. You can't turn it off; you can't discontinue it. That makes it inherently dangerous. Very. I have seen a couple of rough outcomes with this stuff. I take it deadly seriously.

bam_bam · Jul 29, 2004

We rarely use it. We use cervidil primarily. Cytotec scares the youknowwhat out of me!

Beth

CardioTrans, BSN, RN · Jul 29, 2004

The last one I saw it used on, it worked within an hr or so. Within less than 2 hrs she was having contractions every min. After some Demerol, they slowed to every 5. FHTs were ranging 160's-170's. I guess one reason I dont like it is because I cant see it working. I cant control it, like you can with Pit or with the cervidil string.

L&D_RN_OH · Jul 31, 2004

We use it frequently for cervical ripening. Generally, it is placed every 4 hours. Monitored 30min prior to dose, and 2 hours after. We do not give the next dose if the pt is contracting , 5 min apart and/or there is cervical change.

Personally, I prefer it because it offers my pts more freedom of movement. Cervidil requires continous EFM, which really impedes sleep, especially with the nurse coming in every time the pt rolls over to adjust the monitors. Even though Cervidil can be pulled, when it causes hyperstim, the damage is already done. Twice I have seen a pt go from 3 to 10 in less than an hour after hyperstiming with Cervidil, and having it pulled. The only time I have seen hyperstim and/or precipitous labors with Cytotec is when a dose really shouldn't have been placed due to the pt's contraction pattern.

We use it pretty conservatively. Sometimes, it works on it's own. But many times, the pts do get Pit in the am.

ayndim · Aug 1, 2004

I was just curious to see what others thought about the use of cytotec. When do you use it, how do you monitor the patients, are they started on it the night before an induction, if so, do you put them in L&D or on the floor, also, what are your experiences with it?
It kind of scares me, with all the hyperstimulation that it can cause, you cant just turn it off like you can Pit or take it out.
I know tons of questions to be answered, just curious.
Thanks

I thought this thread must be a joke! I cannot believe anyone uses cytotec for inductions. I am only a nursing student so I am not to sure how common it is but I do know the risks and the fact it is contra-indicated in pg women. Scary. I hope the women are at least given informed consent. And told it is not FDA approved for that use. Sorry but as a future l&d nurse I would absolutely refuse to administer it. If a dr wanted to use it he can give and monitor pt him/herself. Maybe I won't have a job for long in l&d. :uhoh21:

And the ACOG is the only body that recommends it use for induction. The FDA and even the manufacturer say it is dangerous to use in pg women. Gosh women and babies die from this drug. Moms have lost babies to this drug and then their uterus too. I would want no part of this drug in an induction.

SmilingBluEyes · Aug 1, 2004

You are right: Cytotec is labeled and marketed as an stomach ulcer treatment/acid antagonist. But,we are not joking here. I promise if you go into hospital-based L and D nursing , the liklihood of your using cytotec for cervical ripening is very high. You you might want to research it a bit more if L and D is in your future --------at least like I said, in many hospitals. Many drugs are approved for off-label use. Brethine ( marketed as a bronchodilator) is one of them; it's off-label use in OB is for preterm labor therapy. Do the research, and decide for yourself IF you can be involved in caring for people where cytotec is in use for cervical ripening.

Have you thought about just trying to go into free-standing birthing nursing???? I think that would be a better bet for you.

ayndim · Aug 1, 2004

You are right: Cytotec is labeled and marketed as an stomach ulcer treatment/acid antagonist. But,we are not joking here. I promise if you go into L and D the liklihood of your using cytotec in cervical ripening is very high, so you might want to research it a bit more if L and D is in your future --------at least in many hospitals. Many drugs are approved for off-label use. Brethine (a bronchdilator) is one of them; it's off-label use in OB is for preterm labor therapy. Do the research, and decide for yourself IF you can be involved in caring for people where cytotec is in use for cervical ripening.

I thought that the FDA still does not approve its use (nor its manufacturer). Has there been a change and I am reading older info. Still don't like it. Honestly, if you (or your wife for the guys) needed to be induced, would you use cytotec?

Okay, I looked it up. I am shocked that the fda site (2003 info) says it can be used. It does give the warnings about the risks. Guess women lose again. This drug, imho, is bad news for induction. :angryfire I sure wouldn't let it be used on my child (no more kids for me). Can you see my jaw still hanging down.

http://www.fda.gov/medwatch/SAFETY/2003/03AUG_PI/Cytotec_PI.pdf

My eventual goal is to be a CNM. But what do you do in the mean time. So the fda is sort of wishy-washy (read the statement on using for induction) but I believe it is bad news. I won't have a problem saying no I won't do it. But how long will I have a job? I sure am not going to have a preventable rupture and fetal death on my watch due to cytotec.

ayndim · Aug 1, 2004

http://www.fda.gov/cder/foi/label/2002/19268slr037.pdf

This statement is only from 1 year before the previous one I posted. What happened? Does anyone know if there were any controlled safety trials?