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Labor induction: Cytotec alert

May 14, 2001 | Ivillage

It is becoming more common for hospitals to use Cytotec (misoprostol or prostaglandin E1) to ripen a woman's cervix and induce labor. Cytotec is a small pill that can be taken orally or broken in pieces and inserted vaginally.

There are growing concerns about the safety of this drug when used for labor induction. A November 1999 Committee Opinion of the American College of Obstetricians and Gynecologists (ACOG) warns: "There have been reports of uterine rupture following misoprostol use for cervical ripening in patients with prior uterine surgery. Thus, until reassuring studies are available, misoprostol is not recommended for cervical ripening in patients who have had prior cesarean delivery or major uterine surgery" (1).

Cytotec's only FDA-approved use is treating ulcers. In August 2000, Searle, Cytotec's manufacturer, sent physicians a letter reminding them that Cytotec was not approved for use as a cervical ripening agent and that it was contraindicated for use in pregnancy (14). The letter listed serious adverse effects associated with using Cytotec, including maternal or fetal death, uterine rupture, and severe vaginal bleeding and shock.

Cytotec is no more effective, and much less safe than Prepidil or Cervidil ( prostaglandin E2), another agent used in the hope of reducing the cesarean rate in labors induced with an unripe cervix. An analysis of 16 trials, in which women were randomly assigned to receive either Cytotec or Prepidil/Cervidil, showed similar cesarean rates (8). Two additional randomized controlled trials comparing the two, and published after the analysis, also found similar cesarean rates (10, 12). Among all 18 trials, totaling 2,550 women who received one labor induction drug or another, cesarean rates were 19 percent with Cytotec and 20 percent with Prepidil/Cervidil. As for safety, a review of 10 studies, totaling 832 VBAC women given Prepidil, reported no uterine ruptures. (4)

Cytotec's sole appeal is price. Cytotec costs pennies per induction, whereas Prepidil and Cervidil cost close to $100 per dose, and more than one dose may be needed (3). Cytotec also reduces the need for intravenous oxytocin (Pitocin), the hormone that stimulates contractions, another savings.