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So can we talk about cytotec... - Page 3

post #41 of 65
Quote:
Originally Posted by Apricot View Post
It's pretty clear the cytotec causes more uterine contractions when given orally - typically beginning to act in 10 mintues. However, it has a longer acting effect when given vaginally or rectally, but doesn't kick in for 25 minutes. I think it's a great second line for hemorrhage, but pitocin is more physiologic and acts in a few minutes. But it's way better than methergine, IMO.
If it were being given for induction, I like the protocols that call for a tablet to be dissolved into water first, then portioned out. So, a 1/4 tablet dose is 25 ml of water after one tablet is dissolved into 100 ml of water. At least then the dosing is actually what is ordered, instead of cutting a tablet with no score lines.
I've never heard of it being given for ectopic pregnancy - only methotrexate. Misoprostol would cause uterine contractions - I can't think of a mechanism to expel an ectopic, but that isn't my area of expertise.
I do think it should be an option for induction. When a mom needs to be delivered for maternal health reasons, but is long and closed, cytotec can get the baby out vaginally. I don't think it should be used for "general" inductions for postdates or convenience. Lots of things are dangerous, but used in moderation in pregnancy. If they weren't needed, no one would use pitocin, antidepressants, asthma medications, beta blockers, or seizure medications, either. There's a reason that Lady Justice carries a scale. Maybe medicine needs a scale, too.
Yup, neither has basically anybody I've talked to about it...one OB had heard of it. It was basically before "they" were doing surgery on the tube and were able to remove the pregnancy without removing the tube (now I know that, at that time, there WERE specialists doing it, but I couldn't even get my regular OB to believe that there was something wrong, let alone find a specialist to see me who hadn't ever seen me before), and they told me that this would expel the pregnancy without damaging the tube.

I've found one written reference to that particular "procedure" since then, in an OLD copy of the dreaded "What to Expect..." but they've since edited it out. Go figure.

Anyway. From personal experience...I certainly wouldn't recommend it. That's not statistical, I know, only anecdotal, but thank you to the pp who mentioned the fact that it was used for her post partum to stop a bleed. I'd be interested to hear of more experiences from the recipients.
post #42 of 65
I haven't read any protocols that include using misoprostol for ectopic pregnancy when it is used to terminate in early pregnancy with mifeprex- only given after an ultrasound- that is done for dates as well as location--
here is some info from the FDA web site
http://www.fda.gov/cder/drug/infopag...qa_4_17_02.htm

"An ectopic pregnancy is any pregnancy that develops outside of the womb. It occurs in 2% of all pregnancies. The ectopic pregnancy is usually in the fallopian tube. As it grows, it damages the tube causing it to rupture (burst) and bleed. Unless it is discovered and treated early, almost 40% of ectopic pregnancies rupture suddenly, causing pain and dangerous bleeding in the abdominal cavity. The other 60% usually cause slow bleeding in the abdomen. Ruptured ectopic pregnancies can be fatal. According to data gathered from death certificates in the U.S. by the National Center for Heath Statistics (NCHS) in 1999, 19 women were reported to have died of ectopic pregnancies.

The Mifeprex label states uses of Mifeprex and misoprostol for the termination of pregnancy is contraindicated in patients with confirmed or suspected ectopic pregnancy. Mifeprex is not an effective treatment for an ectopic pregnancy."
post #43 of 65
Yup. As I said, it's a long story...I believe it was a trial, but don't remember for sure, as the entire summer is like a bad movie being played in slow motion...didn't plan the pregnancy, found out early that I was pregnant, came to terms with the pregnancy just in time to figure out that there was someting just not right. Told doc as much, with a response of "Have you ever been pregnant before? NO? Well, then, how do you know HOW it's supposed to feel!? I don't DO routine ultrasounds before 18 weeks. Go home and enjoy your pregnancy." And, out the door he walked.

I had to seek another doctor to do an ultrasound. Nobody wanted to take me because I was not an established patient. I couldn't afford an emergency room visit if it was in fact just normal "cramping." Finally I went to planned parenthood. They gave me an ultrasound...and we went from there. It was awful, I was sitting in a room FULL of women talking about how they'd had multiple abortions, I really wanted this baby, and needed to know whether I was going to be able to carry it to term. I then had to find somebody to help me end my pregnancy, with which I had JUST come to terms. They recommended a doc, again, I think he was part of a study...I remember signing paperwork... I wouldn't ever recommend it to anybody. I would take having only one tube before I did it again. I just didn't know any better, and they told me that it was a "safe" drug to induce labor, and that that's basically what they were doing, except that they had to end the pregnancy first. They gave me a shot of something that made me pretty sick, and then sent me HOME with a packet of pills to insert vaginally. And the nightmare continued...several times in the next day or three (it runs together) my mom and husband seriously considered bringing me to the ER because of the way I reacted to the drugs. FWIW, it DID expel the pregnancy... Whether or not there's literature about it, it was used on me in that way, and I pray to God that nobody is still doing it...apparently somebody thought it was a great idea to test out a theory...hopefully their theory was proven wrong?...dunno. EVERY practitioner I talk to now has the same reaction, "They used WHAT?! WHAT is that doctor's name!? They sent you H-O-M-E!!!!? Oh my God." Again, it was such a nightmare of a summer that I don't remember most of it, but that's what I do remember.

It was really terrible.

This experience is one of the major things that has led me to do birthwork. The fact that the GOD in the white coat thought he knew more about what was going on in my body than I did and treated me sooo poorly...that really touched something in me. Nobody should be treated like that.

In the end, the pain, bleeding, vomiting, shakes, you name it, is what concerns me so majorly about using it on a woman who is hemorraging. Again, I've also hemorraged post partum...now, my bleed was ten days post partum, but still was an exhausting and scary and LONG day, ending in a d&c that seems to have ruined my uterine lining...I'd hate to see a woman go through all that and have a horrific reaction to the drugs. I mean, gee, if it really does immediately stop the bleeding, maybe not bleeding out would be worth it...but if there were another option, I sure would try it on my client first!!

Sorry. That was long...
post #44 of 65
That sounds awful - bad care all the way around. I'm sorry that you had to lose your baby.

In hearing your story, it sounds like you may have been given a drug to stop the growth of the pregnancy in the tube, and then they induced labor. Typically the treatment is to stop the growth and then wait. There's no need to induce labor, too. That would be torturing someone for no reason.

Used for hemorrhage, women given cytotec often have cramping, nausea, vomitting, increased temperature, and shivering. However, the number of women experiencing nausea, vomitting, and cramping isn't higher than the number of women post partum without any drugs given. Shivering (30%) and increased temperature (8%) are significantly higher than women on a normal course. More side effects than pitocin, but less than methergine.
post #45 of 65
Thanks, Apricot. So basically they put me through the wringer for nothing. Par for the course for the whole situation, I guess. *sigh*

Okay, so, yes, there are side effects when used post partum as well. Makes sense, and good to know. I guess that whatever you use'll have side effects. I had so much pit and methergine when I was bleeding pp that they had to call in a pulmonary therapist with some albuterol...I had a big time asthma flare-up.

Hmmm. Having been on the receiving end, and having had all of those reactions (okay, no fever, had I had a fever, they DEFINATELY would have brought me in), I think it'd make me think twice about administering it if there is something else that might work as well with fewer side effects (pitocin?). Maybe the dosage had a large part to play in my reaction...sorry, musing out loud now.
post #46 of 65
Quote:
Originally Posted by courtenay_e View Post
Finally I went to planned parenthood. They gave me an ultrasound...and we went from there. It was awful, I was sitting in a room FULL of women talking about how they'd had multiple abortions, I really wanted this baby, and needed to know whether I was going to be able to carry it to term. I then had to find somebody to help me end my pregnancy, with which I had JUST come to terms. They recommended a doc, again, I think he was part of a study...I remember signing paperwork... I wouldn't ever recommend it to anybody. I would take having only one tube before I did it again. I just didn't know any better, and they told me that it was a "safe" drug to induce labor, and that that's basically what they were doing, except that they had to end the pregnancy first. They gave me a shot of something that made me pretty sick, and then sent me HOME with a packet of pills to insert vaginally. And the nightmare continued...several times in the next day or three (it runs together) my mom and husband seriously considered bringing me to the ER because of the way I reacted to the drugs. FWIW, it DID expel the pregnancy... Whether or not there's literature about it, it was used on me in that way, and I pray to God that nobody is still doing it...apparently somebody thought it was a great idea to test out a theory...hopefully their theory was proven wrong?...dunno. EVERY practitioner I talk to now has the same reaction, "They used WHAT?! WHAT is that doctor's name!? They sent you H-O-M-E!!!!? Oh my God." Again, it was such a nightmare of a summer that I don't remember most of it, but that's what I do remember.
I can really relate to your post. I was given cytotec in January when I had a miscarriage. The midwife was concerned b/c I was supposed to get on a plane in a few days, and she gave me two options: a D&C at an abortion clinic or, as she put it, "something that will help it happen naturally in about a day." I told her I couldn't go to an abortion clinic, because I knew I wouldn't be able to handle a scenario like the one you described, so the midwife just prescribed me the drug. I wasn't given any other options for the D&C I wanted from the beginning, and I was in so much grief that I didn't think to ask any questions.

3 hours after I took the drug I was in the emergency room after cramping that was so severe and unrelenting that I passed out. My husband called 911 when I went unconscious. The paramedics found me unable to stand or walk with a BP of 80/40. I had a D&E in the hospital and felt fine as soon as I woke up.

I am relieved to hear that your birth experiences were nothing like what you experienced with the misoprostol. I'm pregnant again, due in November, and I am having a home birth. My (new) midwife says that I have no reason to equate the two experiences, because my m/c with cytotec was an unnatural experience, unlike birth. I believe her intellectually, but I still have flashbacks to the pain and how frightened I was. The physical experience ended up being much, much worse than the grief over losing the baby.
post #47 of 65
I am a cytotec placer. I have now said it. I work in labor and delvery as an RN. I hate cytotec because once it's in it's really hard to get out. With cervidil you have a tamponish string to pull it out. And sometimes it causes hyperstim. of the uterus too. But cytotec in the dosage for cervical ripeining is a tiny quarter of a pill. and i have short fingers....
In the dosage for termination of pregnancy, the dosages we use are a lot higher....like 200 to 600 micrograms compared to 25 micrograms for cervical ripeing.
If there was a way to pull it out or it was time released it would be a much better drug.
post #48 of 65
Quote:
Originally Posted by junamoss View Post
I am a cytotec placer. I have now said it. I work in labor and delvery as an RN. I hate cytotec because once it's in it's really hard to get out. With cervidil you have a tamponish string to pull it out. And sometimes it causes hyperstim. of the uterus too. But cytotec in the dosage for cervical ripeining is a tiny quarter of a pill. and i have short fingers....
In the dosage for termination of pregnancy, the dosages we use are a lot higher....like 200 to 600 micrograms compared to 25 micrograms for cervical ripeing.
If there was a way to pull it out or it was time released it would be a much better drug.
This has been a fascinating thread, and is especially timely for me as my next doula client is facing induction.

Junamoss, can you talk a little more about your RN experiences w/ cytotec? How do the mothers respond to it? What happens in the case of uterine hyperstimulation which can't be slowed? Automatic C-sec?
post #49 of 65
The place I used to work used cytotec. We loved it. If I were pregnant and needing to be induced, I'd choose it over pitocin anyday.

Depending upon the cervix and maternal history, we used either 50 mcg or 25 mcg vaginally, followed by another 25 mcg 4-6 hours later if there is little or no uterine activity. If that doesn't do it, we repeat in typically 48 hours if we have time, or if circumstances dictate otherwise, we repeat with typically a single dose of 25 mcg the next day. We kept stats on this, but I don't have them in front of me. Over 90% of our moms had babies within 24 hours of the first does of cytotec.

This was at an out of hospital birth center. By state law, we cannot attend post date births (greater than 42 weeks). We would use the latest date possible (if there was a discrepancy between when the client said her ovulation or conception day, and when an ultrasound said her date was--we didn't do routine US, but if they transferred from a practice that did, or needed one for another reason). We would encourage other forms of induction first--EPO at 36 weeks (it has lots of benefits, not just cervical ripening, and I don't think EPO sends anyone into labor, anyhow), intercourse, accupressure, webster technique to correct any pelvic issues that could be holding up labor, even moxibustion. If none of these worked, we'd try a castor oil recipe, which worked about 70% of the time.

But sometimes none of these things would work, and the mom was looking at either having to birth in the hospital or use cytotec at the birth center. Every mom that was faced with this decision while I was there anyhow chose cytotec. We would give them the informational sheet on it, tell them to go look it up on line, that most of the natural birth community was vehemently against it, and to come back the next day and we could talk about it. Every one of them had very informed consent, lots of discussion. We had a certain criteria that had to be met--no previous uterine surgery, for example.

Another regulation placed on us is that a woman needs to be in active labor with 24 hours of rupture of membranes. Luckily state regs don't state the actual definition of active labor, so we have a little play there. And a tablespoon of castor oil seems to take care of that if we are getting down to the wire. But once a year or so we'll use cytotec for this, too.


We've had excellent outcomes using it. We've never had a case of hyperstimulation or rupture (obviously, or we wouldn't feel okay about using it). We've never had a cytotec induction end in a c-section. We haven't had to use it extremely often; I would guess maybe 2% of our pregnancies? Maybe less; it seems to come in waves, though, where we won't use any for months and months, and then suddenly we use it for two or three moms in one month. The last couple of years I was there, I think we gave it to about 3 moms a year, and we had about 120-140 births a year. We would prefer not to have to use it at all; but we don't have that luxury. Technically we do not give it in the birth center; we give it in the office, where we can run a EFM strip. Our office is a separate entity from the birthing center itself. Then we admit and move them to the birth center when in labor.

My interpretation of the literature, case studies, and reviews of poor outcomes is that the dangers of cytotec are associated with excessive amounts; excessive doses (one study I read, the doc administed it every four hours until active labor); administering cytotec and then adding pitocin on top of it; using it to augment labor; performing AROM during the labor; administering it to women with risk factors for uterine rupture; and not listening to or observing a woman closely enough during labor.

We are very careful when we use it; it is always the woman's choice, we have a pretty lengthy discussion of the pros and cons of it, and we encourage them to check out sites like these to hear other practitioner and natural birth community points of view. They hear all the negatives. They know we'd rather not use it at all, but that we've gotten to a point where we must do something, or they cannot birth at our facility. They always have the option of going to the hospital to be attended our physician; they don't even have to be induced--they can then wait as long as they want. Or if they and we feel induction is needed because of other factors, not just the fact that they are post dates, they will receive pitocin in the hospital.

I would be frustrated if we could not use cytotec. I've seen cytotec births and pitocin births; I would have a cytotec birth over a pitocin induction ANY day. Pitocin is also associated with ALL the same dangers as cytotec.

Just thought I'd throw that out into the ring. I'm impressed with the discussion thus far. It seems as though the discourse will remain civil and thoughtful; I appreciate that.
post #50 of 65

cytotec experience

Quote:
Originally Posted by amygoforth View Post
This has been a fascinating thread, and is especially timely for me as my next doula client is facing induction.

Junamoss, can you talk a little more about your RN experiences w/ cytotec? How do the mothers respond to it? What happens in the case of uterine hyperstimulation which can't be slowed? Automatic C-sec?

It works great when it works. With hyperstim, we would first try to fish it out, iv fluid bolus, turning and brethine to stop contrx. It's never an automatic section where I work. We really just wait and see. Cytotec is not time released, so it has disolved very quickly and acts very quickly in the body.
I am super picky with placement. I really want to be sure that there are no signs of spontaneous labor. I use the bishop score, and if it's greater than 6It is against protocol to place it.

I really feel this is the key to avoiding hyperstim. And if the woman is hypersensitive, it seems that you know right away. I go to the girls with the long fingers to help me dig it out.

I feel like I am extremely critical of fht's and follow the cytotec protocol to the extreme because I come from the more natural side of things, I worked in homebirth and was a doula, wheras a lot of RNs feel like the goal is just to get the baby out. No matter which way. Cytotec requires constant monitoring for 2 hours post placement by our protocol.

I work midnights and have heard that the morning girls get ticked because my pit has to start late.

Of course we have cytotecs that end in section, but usually for fht's, not for cytotec. I have witnessed one placental abruption, it was awful, I came in on days and found it. YIKES. I thought this woman was dying in front of me. She was really tiny and I wonder if the dose was just too big for her. She and the baby were okay. She required a transfusion.

But a lot of times cytotec will put women into labor and they don't require anything additional. If they do we start pit (which i really hate, I am not a pit pusher) We will pit them all day and turn the pit off and restart cytotec the next night if need be. My hospital deals with a lot of family practice docs, so they don't feel that urge to cut so soon.

I had assisted with many wonderful cytotec births.
But it would never be my first option. OR my 10th. It would be very last resort.
post #51 of 65
Thread Starter 
I;ve appreciated it too, and have gotten a lot out of the conversation. I think that people must be completely informed about any drug they use, hearing just one side of the story is never enough.

I was reading through a medical professional board where they are saying that searle(the manufacturing company) is the one that doesn't want to do trials for FDA approval, and that the biggest reason that they sent out that warning letter was because of the approval of RU486(which occured just before the letter was published).
post #52 of 65
I haven't read through the whole thread but I did want to say that I've seen more 'side effects' with Pitocin and Cervidil for inductions than I've seen with Cytotec, but this could possibly be because I've only seen Cytotec used a few times. It's far more common now than it was five years ago when I started (a lot of doulas hadn't even heard of Cytotec and it wasn't in broad use at all), so I expect that I'll see a lot more of it. I know my own OB/GYN doesn't use it for induction and made a face when I asked him like... "eww, no."

The thing I tell my clients is that Cytotec can give you that sweet 8 hour labor where everything flows perfectly, or you can have problems with heart tones that they don't know what caused it, or you can have your uterus rupture, or you can have an abruption, etc.. you just don't know with Cytotec and it's not well studied, nor been in use long enough, for anyone to really hazard a guess at how differently people are going to respond to it.

Truly though, you can say the same things for Pit or Cervidil- both run the risk of hyperstimulating the uterus, causing ruptures/abruptions, etc.
post #53 of 65
My question is this....

My OB really is encouraging me to allow Cytotec to be used to induce me on Thursday. The induction is being done for medical reasons. (see my other post on TAO) I'm wary because of all of the stories that I've heard regarding Placental Abruption and other major side effects.

What can you tell me about your experiences seeing Cytotec being used to induce labor? The OB says that he uses a dose of 25 mg. (or is it mcg? I don't recall exactly.)
post #54 of 65
For my last birth, I had a mw friend try to induce my labor at nearly 39 weeks (I agreed that sooner was better than later for various reasons, and my cervix was plenty ripe/partly dilated already). She brought cytotec, which I'd never heard of at the time (this was 1998), but I trusted her implicitly and she never mentioned possible dangers. She gave me the cytotec orally--1 pill, then 2 pills, then 2 pills again at a shorter interval--this took place over the course of 5-6hrs. I felt nothing at first--no contrax, nothing at all. Then I suddenly began to shake. I shook so hard and so uncontrollably that it frightened me badly. I finally instructed my 2 other friends present to wrap me in a blanket and sit on me, basically. They sat tight against me, and on the edges of the blanket so that I was tightly bound. Finally, I fell asleep--passed out is more like it. I told my mw friend when I woke up that I was done with attempt to induce. Went into spontaneous labor a few days later--with a partial abruption that led to csec.

I would never have taken the cytotec if I'd known the whole story--which I do know now.

My opinion is that cytotec has no place anywhere near birthing women. Period. It's not that it's an 'off label use'. It's that the risks are too huge. And I don't care how many wonderful cytotec inductions anyone has seen, or it's great work on pph. I still think this drug is far too dangerous to be used for birth, at any dose.

And yes, we have an induction epidemic going on, for a variety of reasons. Even apart from all this reasonable and mannerly discussion of this drug, I am really kind of stunned by what I am reading in some here with this discussion, what seems like a cavalier attitude toward that primary fact. WHY ARE THERE SO MANY INDUCTIONS? How have so many people gotten so casual about this? And yeah, given cytotec's unpredictability and the great damage it can cause, why is any woman telling herself or anyone else that it is redeemable with proper use?
post #55 of 65
As someone that was given cytotec with my first birth, I definately slammed into labor and after birthing my 2 nd totally natural, cytotec created a lot of problems for me and did not have a good birth expierience because of it (nothing like natural labor).
post #56 of 65
Quote:
Originally Posted by AugustLia23 View Post
True, cytotec is not approved for it's usage in obstetrics, but then again, neither is terbutaline(brethine, to stop pre-term labor), or fentanyl or reglan, all of which are very widely used. Isn't the main reason it's unapproved simply because it's such a cheap med, and there would be no money to be made in doing an official study of it.
The Cochrane Library, arguably the most reputable repository for obstetric "information, retains a database (www.cochrane.org) compiled by some of the world's best and brightest scientists. This team reviews meticulously the international scientific literature and draws conclusions accordingly. You may be familiar with the database, but I wanted to draw attention to it for other posters.

From a page on Cochrane's website, we see the following (http://www.cochrane.org/reviews/en/ab000941.html):

"Sometimes it is necessary to bring on labour artificially because of safety concerns for the mother or baby. Misoprostol is a hormone given by insertion through the vagina or rectum, or by mouth to ripen the cervix and bring on labour. The review of trials found that misoprostol given vaginally is more effective than prostaglandin and that oxytocin is used in addition less often. However, misoprostol also increases hyperstimulation of the uterus. The trials reviewed are too small to determine whether the risk of rupture of the uterus is increased. More research is needed into the safety and best dosages of misoprostol."

[Emphasis my own].

There is no question about whether or not Misoprostol (a.k.a. Cytotec) works. It does. Its safety, however, remains in question.

I'm not opposed to the use of Cytotec IF its safety is proven by a study that is randomized, controlled, ideally longitudinal and definitely independent (i.e. not sponsored or otherwise influenced by the manufacturer or other parties who stand to benefit). I've yet to see such a study, although there could be one out there!

Given some recent obstetric fiascoes, however, I DO take issue with doctors using Cytotec until such a study is released.

No mention has been made in this thread of Marsden Wagner's book, "Born in the U.S.A," which I'm in the process of reading. Wagner presents a scathing but compelling case against its use. (But then, I need to read other points of view!)

You mentioned clients. Do you work in health care? If so, I'd love to hear your views on the book if you've read it or get around to reading it!
post #57 of 65
I had the ineresting experience of seeing cytotec used two ways at the same time. When I was a labor and delivery nurse at Hospital A, they used 50 mg doses every four hours. These women didn't go into labor, they were launched into orbit. They had crazy hyperstim patterns, fetal bradycardias, forceps/vacuums....I remember one woman who was filled with righteous indignation that she didn't have time for "her" epidural.

I was also a CNM student and at Hospital B down the street I was doing clinicals. They used doses of 25 every 6 hours. The women got an NST, the cytotec was placed, then two hours of monitoring. Then they could be intermittently monitored. They had very nice inductions.

AugustLia, I haven't researched the way you have, but I'm willing to bet that catastrophic events are in doses of 50 or higher.

Lorijds, thank you for your balancing view. Yours is an excellent description of the prudent use of pharmacology, right down to the informed consent.

MsBlack, your experience was tragic. You received what sounds like 500 mg of cytotec in five hours. That's 20 times the recommended dose. If someone were to get 200 units of pitocin or 16000 mg of ibuprofen, bad things will happen. Your midwife friend's hubris had very real consequences, ones that played out on your body. My heart goes out to you. I imagine that your friendship suffered terribly or came to an end.

Thank you for an engaging dialogue, folks....
post #58 of 65
This is very interesting to me as I have just had a VERY positive experience with Cytotec induction (reasons of being post-dates with gestational diabetes and weeks of prodromal labor which required me to take sleeping pills and ran me down physically and emotionally).

The dosage was 1/4 tablet (25 mg) every four hours until active labor. I had my first dose at 10 a.m., second one at 2 p.m., had light contractions starting shortly after the second dose, and my water broke on it's own around 6:15 p.m. Labor followed a natural pattern of 4-5 minute apart until transition, when things changed to 2-3 min. apart, then spaced out more at 9 cm right before pushing, which was only 10 minutes. It all felt very manageable to me, no epidural or pain meds.

My doctor says she's never seen a case of uterine hyperstim when she follows that dosage. She is also a huge fan of natural childbirth, and sees more patients have pain-med free labors with it than with pit. Another doctor in the group uses pit a lot more than cytotec, and his rate of C-sections from inductions is higher than the other docs. A L&D nurse who's worked at our hospital for nine years also said she sees bad stuff happen with pit all the time with mom and baby, but never with cytotec when careful dosage is used. Another doctor I talked to said that in the extremely rare event of hyper-stim, meds can be used to stop contractions.

I just remembered seeing this thread, and thought I would revive it as this subject is very interesting to me.
post #59 of 65
nak

glad you revived it, too!

but i want to reiterate what several pps have said -- cytotec is unpredictable!

i had 3 25m doses, 4 hours apart

horrible (and unproductive) labor that made me ashamed i couldn't handle the pain of childbirth (later found out, after epidural and internal monitoring, that my contractions were off the scale; cnm and rn were having a pretty big argument about whether or not the monitor was malfunctioning; fortunately dp overheard them and later told me)

emergent c/s for fetal distress

i made an "informed" decision to try cytotec, and i believe it was the worst decision i've ever made, both physically and psychologically
post #60 of 65
I just finished having a debate about this in a different venue. Let me sum up what we came to -

- it's not that it's off label usage. It's that it's ON LABEL CONTRAINDICATED.

- that being said, if used in the proper venue under the right circumstances, it can work very well.

- those circumstances include:

1)no uterine scarring
2)an unripe cervix (this is what it should be used primarily for!)
3)one baby only please
4)when PGE2 have failed
5)CAREFUL monitoring with a controlled low dose.

If all of those things are in place, it can be a fabulous option. And trust me, I was on the NO NO NO! side of the fence with this drug. But, it would appear through studies and experience that this drug while not to be commonly used DOES have it's place.
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