What do you think about the use of Cytotec?

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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

At the last hospital I worked at, that's all we used. I didn't realize just how bad it was until I started working at my present job where the docs only use Cervadil, which I like much better. If a mom gets into trouble, I can remove it. Cytotec makes me extremely nervous.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Cytotec whether taken PO or used lady partslly has the same result in my experience. It's unpredictible as hell. It either works or it does not and the effects are equally hard to predict.

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We use cytotec frequently for induction of labor, 25 mcg Q 3-4 hours.. It works great. We do 170-190 deliveries a month. We've used it for 3 years and have had no problems. Almost never causes hyperstim. but if so we use brethine..

Pt.s are monitored for 2 hours after insertion, then may walk for 30min to 1 hour.

They do quite well. The doctors love it..:)

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We use cytotec frequently for induction of labor, 25 mcg Q 3-4 hours.. It works great. We do 170-190 deliveries a month. We've used it for 3 years and have had no problems. Almost never causes hyperstim. but if so we use brethine..

Pt.s are monitored for 2 hours after insertion, then may walk for 30min to 1 hour.

They do quite well. The doctors love it..:)

This sounds like my facility. We're had great results with very few cases of hyperstim. In those cases, if you review the strip and the contraction pattern, generally the last dose shouldn't have been inserted. That is a nurse error, not a med error. Like I said, we use it pretty conservatively. If a pt has made cervical change and/or is having contractions >3 in 10minutes, we don't insert another dose.

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We actually did a chart review of hyper stims when we started using cytotech. We were using both cytotech and cervadil at the time, so we compared hyper stims between the two. The review showed no hyperstims with cytotech, and quite a few with cervadil.

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This is in response to the nursing student who is convinced that cytotec is a dangerous drug that should not be used during inductions. I practice as an RN in boston and did my student practicum at Mass General Hospital, which is one of the best hospitals in the country. They use cytotec all the time for inductions. If used correctly, it does not cause any more hyperstimulation than cervidil. Heres the rundown ( I did a research paper/case study on it):

On August 23, 2000, the manufacturer of Misoprostol distributed a letter to clinicians in the U.S warning them about the use of misoprostol in pregnant women. The letter stated that the use of Cytotec in pregnancy is contraindicated because it can cause abortion. The letter also cited reports of uterine rupture and maternal and fetal deaths when Cytotec was used to induce labor. It also states that the effects of Cytotec on the later growth and development of the child has not been established. Many hospitals stopped using the drug and pregnant women lost access to the drug for any indication. (Goldberg and Wing, 2003) However, in a response issued in December of 2003, the American College of Obsetricians and Gynecologists (ACOG) reaffirmed their previous position that substantial evidence supports the use of misoprostol for induction of labor. In a study done by Dr. Alisa B. Goldberg and Dr. Deborah A. Wing, 5400 women were given misoprostol for induction of labor and 9400 women were given other prostaglandins. The study showed that serious adverse outcomes are extremely rare and that any differences between agents are very small. Other studies have showed that compared to oxytocin, placebo and other prostaglandins, the use of Misoprostol resulted in shorter times to delivery and a lower C-section rate. This was achieved without an increase in the frequency of uterine hyperstimulation associated with fetal heart rate. The data also suggests that the best dose of misoprostol for induction of labor is 25 mcg lady partslly every 4-6 hours. (Goldberg, Greenberg, and Darney, 2001)

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We use Cytotec for induction and have very strict guidelines for it's use. The patients are brought in at 2345 and typically receive two 25mcg doses (placed 3 hours apart) and then are started on pit @ 0700. Exclusion criteria includes a parity >5, Bishop score of 7, multiple gest, contractions more than 5 in 30m. Cytotec works great with early gestation demises and with pph.

We have been doing more foley inductions. Anyone's thoughts on these? How well do you find that they work?

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This is in response to the nursing student who is convinced that cytotec is a dangerous drug that should not be used during inductions. I practice as an RN in boston and did my student practicum at Mass General Hospital, which is one of the best hospitals in the country. They use cytotec all the time for inductions. If used correctly, it does not cause any more hyperstimulation than cervidil. Heres the rundown ( I did a research paper/case study on it):

On August 23, 2000, the manufacturer of Misoprostol distributed a letter to clinicians in the U.S warning them about the use of misoprostol in pregnant women. The letter stated that the use of Cytotec in pregnancy is contraindicated because it can cause abortion. The letter also cited reports of uterine rupture and maternal and fetal deaths when Cytotec was used to induce labor. It also states that the effects of Cytotec on the later growth and development of the child has not been established. Many hospitals stopped using the drug and pregnant women lost access to the drug for any indication. (Goldberg and Wing, 2003) However, in a response issued in December of 2003, the American College of Obsetricians and Gynecologists (ACOG) reaffirmed their previous position that substantial evidence supports the use of misoprostol for induction of labor. In a study done by Dr. Alisa B. Goldberg and Dr. Deborah A. Wing, 5400 women were given misoprostol for induction of labor and 9400 women were given other prostaglandins. The study showed that serious adverse outcomes are extremely rare and that any differences between agents are very small. Other studies have showed that compared to oxytocin, placebo and other prostaglandins, the use of Misoprostol resulted in shorter times to delivery and a lower C-section rate. This was achieved without an increase in the frequency of uterine hyperstimulation associated with fetal heart rate. The data also suggests that the best dose of misoprostol for induction of labor is 25 mcg lady partslly every 4-6 hours. (Goldberg, Greenberg, and Darney, 2001)

What about control (besides brethine which as PTL mom I know has some shaky side effects -- literally) after insertion. What is the protocol. Let no one say I don't practice evidence based care. If something can be proven safe with proper research and documentation I will gladly change my view. I have just heard horror stories about this drug. Are moms informed what the drug is being used and the fact it is being used off-label? Are we required to do that? If not, do you feel it is necessary?

Thanks. Any info is stored in my brain to make me a better nursej one day. :)

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Okay, so can someone explain what cytotec is compared to cervadil??????

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What about control (besides brethine which as PTL mom I know has some shaky side effects -- literally) after insertion.

Are moms informed what the drug is being used and the fact it is being used off-label? Are we required to do that? If not, do you feel it is necessary?

:)

Were you told that treatment of PTL is an off label use of Brethine? Many drugs have off label uses that they are effective for. No, I don't tell pts it is an off label use, because I think it is a moot point. I do tell pts what they are being induced with and what possible side effects are, and ask them if they have any questions or concerns.

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Okay, so can someone explain what cytotec is compared to cervadil??????

Cytotec is a pill. Cervidil is impregnated on a thick tampon like string. They are both inserted lady partslly, both used to ripen the cervix, and both can cause hyperstimulation.

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Were you told that treatment of PTL is an off label use of Brethine? Many drugs have off label uses that they are effective for. No, I don't tell pts it is an off label use, because I think it is a moot point. I do tell pts what they are being induced with and what possible side effects are, and ask them if they have any questions or concerns.

Yes my CNM told me it was an off label use and explained the pros and cons of it.

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