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.
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I guess I would resort to cytotec for myself IF medically indicated. NOT for inductions for choice or social reasons. There ARE reasons we induce people besides this, when PIH gets out of control, for low amniotic fluid indices, or IUGR.....
The benefits CAN outweigh the risks, like in ANY drug used, including Pitocin, Brethine, magnesium sulfate, antibiotics or even Tylenol. You do this with anyone; weigh risk versus benefit. Especially if you are a midwife or OB. And you do your research, as I suggested earlier. It's been used with very safe results the vast majority of the cases on my unit. Yes, there were some bad outcomes, but not necessarily directly correlating ALONE to the use of cytotec. There were other possible factors that contributed to these. Anecdotally, it has been a safe way to ripen cervices on my unit. But there is research out there to consider, naturally. You are smart to look around.
I delivered my first in a free standing birth center with a midwife and I was induced with Cytotech at 41.6weeks.
But at 41.6 wks, weren't you probably a very easy induction - (saying this with no working L&D experience) Pretty ripe and ready to go?
From what I learned on my own, doing research preparing for my 3rd birth, I steered clear of cytotec.. I had cervidil which enabled me to have a pit,med, and most interventions- free birth. (In a hospital) I even got to go sans IV and move about the room.
But at 41.6 wks, weren't you probably a very easy induction - (saying this with no working L&D experience) Pretty ripe and ready to go?
The birth center rarely did inductions--but you could not deliver there after 42 weeks so that is why I had to have a push. I was fingertip, but very soft and fairly thin if I remember correctly. Cytotech was the only medical option provided to me at the time. If I would have refused that, I would have needed to go to the hospital for induction. This was almost 4 yo--I am curious if they are still using it.
We only use cytotec for fetal demise pt's. It seems to work pretty well for them. The other off-label, not FDA approved drug we use all the time is Mag. I'm sure OB isn't the only place in the medical profession using drugs for purposes other than what they were designed for.
I have only seen cytotec (or its equivalent in UK) used prior to late therapeutic abortion or in cases of fetal death and subsequent induction of labour, although as in the US it isn't licenced for this use. Dinoprostone seems to be the drug of choice here for ripening of an unvavourable cervix prior to ARM and use of syntocinon (equivalent to pitocin).
We used it often at the other facility I worked at and sometimes docs would give an oral dose, send people home, and then have them come in for the morning and give them a lady partsl dose. We also used it successfully to combat post partum hemorrhage by giving it rectally. Only once in all the years we used it did I have to give terb to stop or slow down the resulting contractions. We do not use it at my current facility, but I find the same level of concern with the cervaidil we do use..I think, with the cytotec, as with pitocin, in my experience, usually if a cervix isn't ripe or a person isn't ready to go into labor, nothing will do it.....I had no problems with cytotec other than in the beginning when we started using it after finding out the chief was basing his findings on using it on some research on the net and we then had no policies in place..THAT bothered me..
I read all the horror stories about Cytotec too, and was shocked that anyone would keep using it. However, since I've been working as an L&D nurse, I much prefer it to Cervidil. Our cervidil inductions require continous monitoring while Cytotec does not. While it can't be removed after insertion, which seems to be the big argument, it is used very conservatively and in doses moderated by the pharmacy. Our CNM's prefer it to allow their pts freedonm of movement.
Personally, I have seen more hyperstim and kids blown out with Cervidil than with Cytotec, and yet, we continue to use that with no one complaining about it.
If I had to be induced for a medical reason, I would choose Cytotec. I couldn't stand being strapped to the monitor for 12 hours, plus, many pts c/o alot of cervical tenderness following Cervidil placement.
I think if you're planning on working in OB, you will have a hard time finding a facility that does not use it.
I personally love Cytotec. We use it in very low doses for inductions w/o favorable cervix. Higher doses for demises. It's a great pph drug. Doesn't usually cause diarrhea like carboprost. We haven't had any problems with it, used properly. In our facility, only docs place it.
SmilingBluEyes
20,964 Posts
I guess I would resort to cytotec for myself IF medically indicated. NOT for inductions for choice or social reasons. There ARE reasons we induce people besides this, when PIH gets out of control, for low amniotic fluid indices, or IUGR.....
The benefits CAN outweigh the risks, like in ANY drug used, including Pitocin, Brethine, magnesium sulfate, antibiotics or even Tylenol. You do this with anyone; weigh risk versus benefit. Especially if you are a midwife or OB. And you do your research, as I suggested earlier. It's been used with very safe results the vast majority of the cases on my unit. Yes, there were some bad outcomes, but not necessarily directly correlating ALONE to the use of cytotec. There were other possible factors that contributed to these. Anecdotally, it has been a safe way to ripen cervices on my unit. But there is research out there to consider, naturally. You are smart to look around.