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Re: Cytotec vs. Cervidil

From: William D. McIntosh, MD (anonymous@obgyn.net)
Fri, 12 Feb 1999 14:02:35 -0600 (CST)

>Dr. McIntosh.
>
>I am not convinced that Cytotec is better than Cervidil. From what I
>have been reading, the dosage of Cytotec that is applied to the cervix
>is not as controllable as Cervidil, and may cause frequent, tetanic
>contractions, which I believe is a contraindication, especially in a
>woman with a uterine scar (though ruptures can occur in unscarred uteri
>as well).
>
>I disagree that Pitocin is "the very same hormone that your own body
>makes to have contractions." Pitocin is synthetic oxytocin and not the
>same thing. Michel Odent is doing research on Pitocin and is finding
>evidence that the pituitary gets "tricked" into thinking it has already
>produced enough Pitocin and therefore stops making it... therefore
>requiring more Pitocin to keep the labor going. He also says that
>oxytocin (the natural stuff) is the "hormone of love" and is at the
>highest levels it will ever be in both mother and baby in the first few
>hours after birth. If Pitocin has been used continually, natural
>oxytocin won't be present, which can hinder the bonding process in those
>crucial first hours after birth.
>
>>Why do you need an induction? Maybe you will go into labor on your own.
>That is the best way of all.
>
>Agreed!!
>
>--
>Amy DeRuyscher
>Provisional Birthworks CCE
>Provisional Birthworks Doula
>

I appreciate your opinion, but I am afraid that I cannot share it. Cytotec can be used badly, but that is not a reflection on the drug, but rather the user. All ripening agents share that same concern, that the dose is variable, and the effects not always predictable. That is Cervidil's main claim to fame, that you can pull the string if there is hyperstimulation of the uterus. You can just sweep out the Cytotec tablet, one of its strengths. The use of cytotec outside of L&D is untested, and frankly dangerous. So would be the use of Cervidil in that fashion.

As for Pitocin, oxytocin from a test tube and oxytocin made in vivo are chemically identical. Any arguement that Pitocin is somehow different is going to have to explain to me how identical molecules can behave differently. To use the example of sucrose (sugar), whether it comes from a sugar beet or sugar cane, it is still sucrose. Any contraindication to pitocin is a contraindication to labor in equal weight.

Both cervidil and cytotec have been used in thousands of women safely. I have used cervidil for several years, and prostin gel before that. I started using Cytotec just in the past year. My experience is the same as the literature, it works quickly, safely, and more reliably than cervidil. I do not use medications for my convenience, certainly not one that might get me sued. I pick the best possible agent that I can find, and the only outcome variable that counts is a healthy baby and a healthy mother. I would use cytotec in preference to cervidil in my wife. 

--
William D. McIntosh, MD
Clarksville, TN


This is for educational purposes only.  It is not intended
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