Cytotec is the trademark name that Searle Pharmaceticals uses for its Misoprostol. A synthetic prostaglandin, it is approved by the FDA for the prevention of nonsteroidal anti-inflammatory, drug-induced gastric ulcers. It is a small and inexpensive pill that is normally taken by mouth, but some physicians will use it to induce labor by oral administration or by placing it inside the vagina.
In 2002 the FDA approved a new label for cytotec to address concenrs when used in cervical ripening and for induction of labor. This label provides information for women who are being offered cytotec as a labor ripening agent to understand the risks, however the FDA maintains it has not been given proof cytotec is safe for use in labor. This label can be read at the FDA website.
Prostaglandin is one of the chemicals that play a part in ripening the cervix. A ripe cervix is soft and stretchy, ready to respond to uterine contractions. Cytotec is known to ripen the cervix and cause strong uterine contractions regardless of how it is taken.
Cytotec is proven to start labor faster than pitocin, and use of cytotec provides faster labors than pitocin. Cytotec is cheap and easy to store making it available in a variety of settings.
Risks for Mother
- Increases risk for uterine hyperstimulation.
- Increases risk of uterine rupture.
- Once administered, its effects cannot be stopped.
- Hospital policy may require continuous monitoring of baby's heart rate which decreases mobility.
Risks for Baby
- Uterine hyperstimulation can cause abnormal fetal heart rate.
- Increased rates of meconium-stained fluids.
Cytotec for inducing labor began as an off-label use. This means the medication, though approved by the FDA, was never approved for use during labor. However, once a medication is approved by the FDA doctors can prescribe it for other things as well. This off-label use of cytotec lead to some very strong objection among the birth community. Many caregivers felt the use of a medication in labor before it had been studied for safety was unethical.
There are now many studies of the use of cytotec to induce labor. There are still different methods of using cytotec, vaginal administration, oral administration, and using dissolved cytotec in water at regular intervals. Cytotec is also used for preventing postpartum hemorrhage in women who continue to bleed after giving birth. Administration for this purpose may be oral or rectal. Ask your health care provider what method of administration will be used.
For more information about Cytotec
Pfizer, the drugs manufacturer, has information online. You can view it at their web site by clicking here.
Marsden Wagner, MD, MS wrote an article about the use of cytotec for Midwifery Today in 2003. In it you can learn more about the controversy that surrounded cytotec when it was first used for induction.
Despite its initial controversy, there are now many studies about the use of cytotec to induce labor. Review some of them at PubMed to get a better understanding of the risk and benefit before making your decision.
Goer, Henci. The Thinking Woman's Guide to a Better Birth. 1999. New York: The Berkley Publishing Group.
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.