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Re: Cytotec vs. Cervidil

From: William D. McIntosh, MD (anonymous@obgyn.net)
Wed, 10 Feb 1999 20:40:43 -0600 (CST)

At Tue, 09 Feb 1999, Christopher wrote: >
>OK- I'm 34 weeks pregnant with my fourth child. I have been induced with my
>other three children, twice with Pitocin alone and once with Cervidil
>alone. Obviously I preferred the Cervidil. My first induction ended in a
>C-section due to fetal distress since then I have had two successful
>VBAC's-the last being with the Cervidil. Here is my situation/question: my
>midwife has agreed to try the Cervidil again (if needed) since it worked
>so well the last time(contractions within 45 minutes of
>application/delivery in 5 hours-AND with a Bishop's score of 5 at start of
>induction-go figure:)). Since it worked so well last time is it probable
>that it will work as well again? Or is everytime different?She is reluctant
>to use Cytotec since I have a uterine scar. She says that I'd have to be on
>continous fetal monitoring if I have the Cytotec but won't if I have te
>Cervidil. I'm assuming if I have the pit I will also need to be on the
>monitor continously. Question then-which is the lesser of two evils if the
>Cervidil doesn't work? Cytotec or Pitocin?
>
>TIA for your opinions
>
>Karen

Neither you nor your midwife may like my answer. Cervidil is a good system, but Cytotec is better, cheaper, faster, and safer (the last is my own opinion, though I think it is supportable in the literature). Frankly the two have slightly different indications, also in my opinion. Cervidil is good for ripening an unripe cervix. The fact that you delivered so quickly with it tells me that your baby needed just the smallest nudge to hit the road so to speak. Cytotec takes you to contractions faster, as well as ripening the cervix. The time to labor, and the time to delivery are shorter, with no increase in complications. You can also dose more frequently if necessary.

I do not understand being afraid to use Cytotec for a VBAC, when she appears to be willing to use the other agents. There are those that will not use any agent for a VBAC, but all agents have the same results, contractions. If you are willing to use one, you should be willing to use the others, at least in principle.

Pitocin is not a good agent for use with an unripe cervix, but if you are contracting, the other two agents are contraindicated. Plus, pitocin (after all, this is the very hormone your own body makes to have contractions) is adjustable, has a short half life (so it goes away quickly if you need it to), and most importantly, gets the job done.

Why do you need an induction? Maybe you will go into labor on your own. That is the best way of all. 

--
William D. McIntosh, MD
Clarksville, TN


This is for educational purposes only.  It is not intended
 to replace consultation and examination by your physician
 or other health care provider.



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