So can we talk about cytotec... - Page 2

[bryonyvaughn]

Originally Posted by etoilech

...The argument over cytotec (misoprostol) is moot for me. Where I live misoprostol is contraindicated during pregnancy. Period. Anyone giving it pregnant women here would risk losing their license.

Well don't keep it secret! Where do you live?

BV, who thought such a place only existed in her dreams

[monocyte]

Originally Posted by katja

A brave woman you are, AugustLia! :

:

[AugustLia23]

Hey, I will take that as a compliment. I am getting used to being the different voice. I just want there to be a sound judgement on the drug one way or the other. I won't be pointing anyone towards it anytime soon, but it'd be nice to have some reliable results from reliable studies.

It's hard to have studies done on this sort of thing though, I mean, I wouldn't be signing up for the study...

It's definitely not okay to risk moms and baby's lives in the name of science.

[AugustLia23]

Originally Posted by jessie.gray

After reading the book "Born In The USA" and hearing all about these women who have died after being induced with Cytotec, I would never want it in my body. You can have bad side effects from with WITHOUT having a prior C-Section scar. I read online that some first time mom's have had to have hysterectomy's and have died after being induced with Cytotec. Plus, I have read that Cytotec causes more fetal stress than any other labor inducing medicine on the market.

Jessie
(single mommy to Emma, 3 years and Angela, 2 years)

Do you know what the dosages were? Mom's likely weren't having these side effects from 25mcg per 4-6 hours...probably closer to 50-100mcg

[Ellie'sMom]

Originally Posted by AugustLia23

I wonder what it is in the woman or the cytotec that causes some women to respond so well to it, some women not to respond at all, and some women to have these catastrophic events...

I'm not sure it is something about a particular woman, rather than something about that particular pregnancy. I have used cytotec twice to complete an incomplete miscarriage. The first time I hemmorhaged and had to go to the ER in spite of the fact that some of the tabs (intravag.) fell out an hour or so after insertion. The second time (long story about why I decided to try it again) it did nothing at all even with a repeat dose. The primary difference I think was that with the first pregnancy I had been spotting for 2 weeks, whereas with the second we found no heartbeat on u/s, but I had no symptoms of m/c. I have always assumed that my body was just really ready the first time and not so much the second.

[mwherbs]

unfortunately many of the ruptures have occured without it even being in a study so harder to find in the lit--- so I by far prefer a study where women are told that they are using an experimental drug...
also I think that there has been a bigger cost to unofficial off label use and that is the withdrawl of VBAC on a national level- I do believe that the increase in rupture that was being reported via insurance was related to cytotec being used on VBACs -- there is a pretty decent risk list in the CNM journal maybe 2 or 3 years ago---
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[AugustLia23]

I definitely don't understand the usage with VBAC moms, especially if they are aware of that increased risk of rupture witht he drug alone.

It also makes you think a lot more about why so many moms "need" to be induced in the first place...

[pinksprklybarefoot]

FWIW, they gave me Cytotec to stop a pp hemorrhage. I was very anti Cytotec before going to the hospital and would have refused it as an induction method. I had a CPM as my labor support (I was originally supposed to homebirth) and we had a few conversations about it. She thought it was a very dangerous drug for inducing labor.

However, when I hemorrhaged and the CNM recommended the Cytotec (which I did not know could be used for hemorrhages), I turned to my CPM and asked if it was a good idea. She said that it was. So I let them give it to me. The hemorrhage stopped and I had no side effects. Don't know if that is what usually happens, but for the purpose of stopping severe bleeding, it worked for me.

[turtlewomyn]

I also just read Born in the USA, and it really scared me. I know that many of the horror stories occurred before they knew "safer" dosages to use, but it bothers me that doctors experimented with this drug on women without their knowledge or consent. I had a former coworker who lost a nephew due to Uterine Hyperstimulation, she told me that they sued the doctors for not doing a c-section in time, but I doubt that uterine hyperstimulation occurs on its own without inducing drugs.
Anyway, in an event where the mom or baby is in danger (i.e. pre-E), inducing might be preferable to just going in and doing a c-section, I would think. However, I hear way too many stories of women who were induced at 38 or 39 weeks because they were sick of being pregnant, or because the doctor was going on vacation. I seriously doubt that these women were informed that they could be putting their lives or their children lives in danger.

[birthgreeter]

Originally Posted by pamamidwife

thanks, BV - it's a perfect explanation as to why Evening Primrose oil *could* work to soften the cervix.

Agree!

[pamamidwife]

I think that cytotec for postpartum hemorrhage or even to induce an early miscarriage is a wayyyy different situation than a term pregnancy induction.

[Jane]

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.

[etoilech]

Originally Posted by bryonyvaughn

Well don't keep it secret! Where do you live?

BV, who thought such a place only existed in her dreams

Switzerland but, we're moving to the UK. It's also contraindicated there.

[DoomaYula]

When I was pregnant with my twins, I was induced (for TTTS and IUGR in one twin) at 34w with Cervidil. When I moved here and started being a doula, a CNM told me they use Cytotec because it costs 25 cents vs $500 for Cervidil. I don't know if Cervidil is safer (although I think it's approved for use in pregnancy and labor, right?) but it bothers me that our local hospital uses it just based on the cost. Although I'm sure it's not the only drug that is used specifically because it costs less than better drugs, but that's another thread.

[mwherbs]

last year a dosage of cervadil cost- $150 which is PGE 2
it is in the form of a vaginal insert so can be removed and the process can be stopped--- not as many ruptures associated with the use -


and yep one dose of Misoprostol is about $1.00 which is PGE 1
one or 2 pills taken orally or intervaginally/intercervical placement hard to find to remove and cannot withdraw it if taken orally--
that is why there is a big multi-center study making a vaginal insert so it can be removed---

[DoomaYula]

So it can't be removed or anything if the mom is having a problem? Eeek. I remember having the cervidil removed after I got going in active labor.

[mwherbs]

imagine tiny little pill meant to be taken orally that is what is put into the cervix some may put it in the vagina but for the most part they are trying to get it right up into the cerivx and it is a different pge 1 and the critter stuff is pge 2.

and they have clinical trials that will be going on in the UK ending in 08 the name of the drug is Isprolor--

here is a promotional web site on misoprostol-- under availability is where I found the info about the UK

http://www.misoprostol.org/File/guidelines.php

[ZoeyZoo]

Originally Posted by AugustLia23

It also makes you think a lot more about why so many moms "need" to be induced in the first place...

IMO, this is why this drug is so dangerous. You are giving these untested interventions usually out of convience; not need for the saftey of the mom/baby. As we all know one interviention is likely to lead to another intervention.

From a lot of the birth show's I've seen like "A Baby's Story", I'm sure most of the moms think this drug is tested and safe. I've actually seen doctors on that show tell moms there are no side effects to pit and the epidural and that they're completely safe. Next thing you know the baby is in distress and they're setting up an OR room for a C Section. I'm sure most moms don't receive full disclosure on this drug either or the ricks of induction in general either.

[StacyL]

THis has been said already, but I second the rec that you need to read Dr. Marsden Wagner's book, "Born In The USA."

I also went to an anti-cytotec rally here in D.C. last year at the annual ACOG conference and they had a huge quilt embroidered with the names of Moms and babies that died from cytotec. It was very sad and disturbing. The woman who organized the rally did get a meeting with the vice president of the ACOG, although I don't know what the results of it were.

[Ixcuina]

Originally Posted by AugustLia23

.

Almost all of the rupture, HIE, and Amniotic fluid embolism stories that I have heard are either 1. because mom had previously had a c-section, regardless of type, 2. because they gave mom too much of the drug too often, or 3. the drug was clearly contraindicated in the mom-to-be(i.e. grand multiparity).

Well, the one story I know about personally (I knew the Bradley instructor that the mom took classes from), had none of those issues. I know it is simply "anecdotal evidence", but she was a first time mom, had an amniotic fluid embolism (cannot be "proven" the tear was caused by cytotec, of course)...

Her husband lost both her and their baby.

http://tatia.org/index.html

PS. The cost factor is part of what really irks me...the fact that cytotec is so darn cheap and Prepidil and Cervidil (the "easier to remove" options) are not so cheap...hmmm....wonder if that plays a factor in cytotec's popularity?