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Microsoft word - misoprostol _cytotec_ for cervical ripening procedure 2-1
PROCEDURE: MISOPROSTOL (CYTOTEC) FOR CERVICAL RIPENING
PURPOSE: For ripening an unfavorable cervix in patients for whom there is a medical or obstetrical indication for the
induction of labor.
Misoprostol (Cytotec) is contraindicated for vaginal use in:
1. Patients with known hypersensitivity to prostaglandins. 2. Patients with clinical suspicion or definite evidence of fetal distress. 3. Patients already receiving oxytocic drugs or prostaglandin ripening agents (recommended that these agents be shut off at least 2 hours before Cytotec administration). 4. Patients for whom vaginal delivery is not indicated. 5. Non-vertex presentation. 6. Patients with significant asthma. 7. Never to be used on patient with a prior history of significant uterine scaring including cesarean birth. 1. Misoprostol (Cytotec), 50 or 25 microgram tablet. BCHCC supplies Cytotec 100mg, break pills in half or quarter to 2. Fetal monitor. 3. Gloves 4. K-Y Jel (optional-depends on doctor) 1. A physician/physician assistant (P.A.) order is required for use of Misoprostol. 2. Baby must be vertex. 3. FHR data is reassuring. 4. Cervix is 3 5. Painful contractions are less frequent than every 3-4 minutes and do not last > 50-60 seconds repetitively. 6. Palpated uterine activity not uncomfortable to the patient is 5 in 10 minutes x 20-30 minutes. 1. Explain the procedure to the patient. An informed patient is more relaxed. 2. Obtain Cytotec from pharmacy. One full tablet is 100 micrograms. Half or quarter tablets are used. 3. Confirm vertex presentation. Non-vertex presentation is a contraindication for Cytotec use. 4. Place the patient on external fetal monitor. Obtain a baseline strip for 20-30 minutes, and must be reassuring. 5. Record vital signs initially and then as ordered. Baseline vital signs are necessary to detect deviations from normal. 6. Insert saline lock. If a MD does not want an IV lock initiated, write an order to that effect. 7. A. Misoprostol (Cytotec) is inserted by the physician/P.A. high into the posterior vaginal fornix. Do not insert into cervix. Be careful that tablet does not come out on glove mixed in with lubricant. The patient should remain in supine position for at least 30 min. to minimize leakage from the cervical canal. B. Administer cytotec po as directed by physician. 8. Continuous toco and ultrasound for a minimum of 2 hours after insertion or as ordered by physician. After 2 hours, monitor at least 20 minutes every hour. Monitor for tachysystole and fetal well being. Notify physician/P.A. of tachysystole or nonreassuring fetal heart patterns. 9. Document cervical exam. Repeat exam as indicated by labor or to evaluate need for subsequent doses. Exams will determine status of cervix and provide baseline for indication of subsequent doses. 10. Subsequent doses of Misoprostol (Cytotec) 25 micrograms may be administered 4-6 hours after initial dose. Again, place high in vaginal fornix. May repeat 3 or 4 times at 2-4 hour intervals depending on uterine activity. 11. Oxytocin may be started on physician order no sooner than 2-4 hours after last dose of Misoprostol (Cytotec). 12. After Cytotec is given, an OB may leave 2-4 hours later upon physician dismissal order.
Nicotine & Tobacco Research, Volume 11, Number 6 (June 2009) 722–729 Original Investigation Nicotine withdrawal symptoms following a quit attempt: An ecological momentary assessment study among adolescents Rinka M. P. Van Zundert , Emiel A. Boogerd , Ad A. Vermulst , & Rutger C. M. E. Engels Abstract Introduction Introduction: The present study describes gr