Cytotec

[nova22]

Tell me everything you know about this inducing drug, please.

[*Milk-Fairy*]

midwife gave it to me with my first child, induced for PIH. Had a fast (5 hour), intense labor. Contractions were right on top of one another, short in duration but without much of a break in between. Baby wasn't breathing when she was born, had to be deeply suctioned but then did fine.

When we requested records from that midwife for our second birth (another midwife birth) we learned that Cytotec was never mentioned in the records. Additionally, I know of two other women that requested records and Cytotec wasn't mentioned in their records either.

After the fact I read a Mothering article that said Cytotec can cause uterine rupture. The makers of the drug do not support it's use on pregnant women. Many doctors won't touch it, (although many will without hesitation), and I assume that if it were safe and acceptable to use that it would show up in my records...right?

[LoveChild421]

I know that it is not approved by the FDA for use in pregnant women as a labor inducing agent. I have heard lots of horror stories. I would avoid it like the plague! Cervadil seems safer if you are wanting to go the medical route.

[CortLong]

I wouldn't touch that stuff with a 50-foot pole!

[nova22]

Thanks for your replies.

My SIL was induced with Cytotec earlier this week. When she told me, my jaw literally dropped (we were on the phone so she didn't know I reacted). I didn't say anything, because I wanted to be sure I knew what I was talking about. Now that I realize I was right in being angry at her midwife, I am wondering if I should tell her or not. She is fine and so is her baby. Are there any adverse effects that can occur a few days or more after it is used?

[Electra375]

Cytotec is dangerous stuff. An OB nurse that works at a local hospital has had it and requested it for her births -- like it was no big deal they use it all the time.
The mothering article on Cytotec is a good one, read it and pass it along to your SIL (just do a search for it on the mothering homepage).
Cytotec does cause uterine ruptures in woman, woman without prior c-sections to boot.
The FDA does not approve of it's use in Obstetrics, yet it continues to be used this way. The OBs don't even concur on the doses used.
You were right to think this is an aweful thing. I can't believe midwives are supporting the use of this drug -- was she a CNM? Some midwives are unfortunately MEDwives.

[doctorjen]

Despite the fact that Cytotec is not FDA approved for use in labor, there is a huge body of literature on its use for induction of labor. The manufacturer has not sought FDA approval so as not to open itself to the possiblity of lawsuits due to bad outcomes. Now they can simply say "We never said you could use it in pregnant ladies" if there is a bad outcome.
There are different opinions on Cytotec out there. Most medical providers would probably consider it safe and effective for cervical ripening when used cautiously. It can be helpful when a medical induction is necessary (such as pre-eclampsia, or something similar) and the cervix is very unfavorable. Unfortunately it is used in a lot of places for elective inductions in women with unfavorable cervical exams. Previously, such a patient might have been encouraged to wait for natural labor, but since Cytotec is known to increase the success of induction for patients with unfavorable cervixes, they are offered inductions instead. It is more effective for cervical ripening than the prostaglandins which are FDA approved.
Our hospital requires a consent form to be signed by the woman which states the possible risks and the fact that it is not FDA approved. I think it's use should definitely be closely monitored and documented, and women should always know and have agreed to what they are being given.

[stafl]

you can read lots of scary stuff at www.fda.gov - just do a search! You can find the label info, the patient info sheet, and all that stuff.

all I know is it nearly killed my DD when they gave it to me. It did not induce labor, but her heartrate dropped to 10 beats per minute! cesarean very quickly followed.

[um_hanna]

there is a sign on the bottle that has a x on a pregnant woman meaning not to be used on pregnant woman...women have died giving birth due to being given this drug...what type of midwife would do this?????? now im mad

[Clara]

Directly from the manufacturer's insert:

Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony. A major adverse effect of the obstetrical use of Cytotec is hyperstimulation of the uterus which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported.

There may be an increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec; including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity also appears to be a risk factor for uterine rupture.

The effect of Cytotec on the later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labor have not been established. Information on Cytotec’s effect on the need for forceps delivery or other intervention is unknown.

The ONLY reason this is still used by OBs and medwives is because of $$$. One dose of this is approximately $0.25, while an actual approved cervical ripening agent is hundreds of dollars. And this is an oral tablet that needs to be cut in half or quarters in order to administer vaginally (there's no good way to get an accurate dosage).

Here's a link that has lots of good information on Cytotec and informed consent:

Tatia Oden French Memorial Foundation

[DallasCPM]

Milk-fairy--- I bet anything we had the same midwife the first time around.

My first was induced with Cytotec. She sent it with me to self-administer at home. Told me it was "gentle and natural -- just like Evening Primrose Oil."
Oh course, at that time, I trusted her because she was my midwife.

Never again. I can't begin to explain how awful the stuff was. Hyperstimulation of the uterus doesn't begin to explain what happened.

And nope! No mention of it in my records...

I would never go to a midwife who carried or used the stuff ever again. My second birth was a breeze (even with back labor!) compared to cytotec.

[JanetF]

There's an article on it at www.hencigoer.com It sounds really scary to me.
J

[lorijds]

We have used it. I've discussed this before on these forums, so I won't go into it again; however, I feel like we use it safely and prudently, and with informed consent.

And I don't feel that we are medwives. But everyone is entitled to their opinion.

Lori

[lorijds]

The thread is bumped, on the midwives and doulas forum, for your reading pleasure!

[stafl]

I personally, was not informed, nor did I consent to the use of Cytotec. All doc told me was that it was an ulcer medicine, quote, "like reglan" and that it would ripen my cervix so the pitocin would work better.


the safety of using cytotec to induce labor has not been studied, nor will it be. If studies come out saying it's not safe, then they won't be able to use it off-label for that purpose any more.

[doctorjen]

Actually, there are studies on the safety and effectiveness of using Cytotec to induce labor, just no studies performed by the manufacturer. Go to pubmed and type in misoprostol and cervical ripening to see many. One recent one looked at I think 2000 women, so there are even large numbers available.
I am not a big fan of Cytotec, and feel it has been overused and misused in many situations. However, I think it has a role, and can be used safely, with good consent and close monitoring.

[2+twins]

I know someone who was recently given this drug. She was a first time mom having contrax 3 minutes apart but was staying at 1 cm dilated. She had hyperstimulation of the uterus as a result and the OB said that her uterus might rupture and did an emergency c-section. She was never told what this drug was or anything. Just that it was something they did for induction. She believed her OB saved her life (not relating the hyperstimulation to the drug - she just thought this was a side effect of normal labor) and thank God he was there (honestly I think her comment was a stab at people like me who homebirth since I wouldn't have had the "safety" of the hospital had this happened to me). I have to say it bugged me a bit to hear her praise the man who put her & her baby's life at risk. But that's what this drug does. I agree that the article here on Mothering is excellent. Anyone have any good info on the use of this drug to control hemorraging AFTER the birth? I don't know anything about those risks vs. benefits. Thanks.

[mwherbs]

Originally Posted by Clara

The ONLY reason this is still used by OBs and medwives is because of $$$. One dose of this is approximately $0.25, while an actual approved cervical ripening agent is hundreds of dollars. And this is an oral tablet that needs to be cut in half or quarters in order to administer vaginally (there's no good way to get an accurate dosage).

generic name-MISOPROSTOL
You have the cost wrong it is about $1.00/pill at discount probably at regular pharmacy $1.50 or more.
also used as a component in RU486 after the initial pill it is the follow up pill

I think that the reason that is it used is because it is more successful at inducing and produces a rapid induction if effective- When first used it was used on tons of people and probably was one of the things that increased uterine rupture in VBACs- leading to the fear of VBACs we are at now- but it is still a rare side effect so if a care provider hasn't seen one it isn't a real complication where as C-Section from failed induction is a real complication of many failed inductions. Not that I agree with it's use for induction just that I have talked to care providers and it is more about speed and effectiveness...

[doctorjen]

It can be used for stopping postpartum hemorrhage, but the doses required generally produce pretty bad side effects, so it is generally not used that way.
I have seen cases like love_homebirthing described where it was administered to someone already having contractions and hyperstimulation then occurred. It carries a risk of hyperstimulation anyway, so to add it on to someone already contracting is not a great idea. At least pitocin has a short half-life, and can be quickly turned off if hyperstimulation occurs. Misoprostol cannot usually be removed once it's applied.
Accurate dosage is hard, too. The smallest tablet made is 100 ucg, but usually 25 ucg is used for cervical ripening, requiring the small tablet to be cut in quarters. The tablet can sometimes then get stuck in cervical mucus and not dissolve. Then when subsequent doses are administered, they can all dissolve at once and be absorbed, leading to hyperstimulation (plus hyperstim can occur even just with a normal dose.)

[natashaccat]

My OB used this on me for an elective induction on my due date (absolutely no medical reason, I didn't know any better) w/o informing me of potential risks or safer alternatives. I immediately started contracting w/o cerxix dialation. After a 31 hr stay in the hospital that nearly ended w/csect due to failure to progress I finally went from 5-10 cm in about a half hr and was able to give birth vaginally.

IMO this really is an issue of informed consent, there may be situations where CYTOTEC is a viable choice but Dr's should not be allowed to administer a questionable drug w/o fully informing patients of it's risks and alternatives. I went in for my induction thinking that they would be using cervidil which I'd read about in many pg books and felt comfortable with. I didn't fully realize the something else had been used until after the fact when I overheard the nurses talking to each other about how my labor wasn't progressing normally and that I'd have to be closely monitored because cytotec behaves so unpredictably.