More on Cytotec, Cervidil, and Pitocin

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The following are some anecdotal comments interspersed with some reference to articles. There are pros and cons to each. Good for you for taking the time to research this during your pregnancy. My motto is, "If you don't know you have any choices, you don't have any."

>From a nurse:
>From a nursing perspective, we would rather work with cervadil than
cytotec (which is also called misoprostil) because the cytotec is so unpredictable. At least with the cervadil, you can pull it out because it is attached to a string (like a tampon). The cytotec is a little miniscule pill which is placed in the posterior fornix (behind the cervix). It's hard to retrieve and as I said, very unpredictable.

*** Please check out the midwife archives for lots of discussion on cytotec vs. Cervadil: http://www.fensende.com/Users/swnymph/Midwife/cytotec.html

*** >From http://www.rxmed.com/monographs/prostin2.html

PROSTIN® E2 Vaginal Gel

Pharmacology: Dinoprostone is a synthetic analogue of Prostaglandin E2 (PGE2). <snip> Labor should not be induced in patients who have any of the following: Patients in whom oxytocic drugs are generally contraindicated or where prolonged contractions of the uterus are considered inappropriate. These include the following situations: patients with a history of cesarean section or major uterine surgery; patients with cephalopelvic disproportion; patients with a history of difficult labor and/or traumatic delivery; grand multiparae with 6 or more previous term pregnancies; patients with suspected or clinically evident pre-existing fetal distress; patients with overdistention of the uterus (multiple pregnancy, polyhydraminos); patients with pre-existing uterine hypertonus; circumstances that make it impossible for a responsible physician to be present. Patients with ruptured membranes; engagement of the head has not taken place; patients with unexplained vaginal bleeding during this pregnancy; patients with fetal malpresentation; patients with gynecological, obstetrical or medical conditions that preclude vaginal delivery. Dinoprostone vaginal gel should not be used simultaneously with other oxytocics (see Precautions).

*** Induction of labour by different methods in primiparous women. I Some perinatal and postnatal problems.

Ounsted MK, Hendrick AM, Mutch LM, Calder AA, Good FJ

A personal prospective study was made of some perinatal and postnatal problems associated with induction of labour by three different methods in primiparous women with unripe cervices. The methods of induction were: (A) amniotomy followed by intravenous oxytocin [49], (B) amniotomy followed by intravenous prostaglandin E2 [39], (C) prostaglandin E2 by the extra-amniotic route [42]. A spontaneous group (D) comprising 54 mother--infant pairs was also studied. Length of gestation was between 37 and 42 wk in all but 2 cases. There was no perinatal mortality, and no infant had hyaline membrane disease. A close association was found between method of delivery and method (or absence) or induction. The caesarean section rate was highest in group C and lowest in group D. The spontaneous vaginal delivery rate was lowest in group C and highest in group D. More infants in the three induction groups were admitted to the Special Care Baby Unit (SCBU) than in the spontaneous group. No significant associations were found between the severity of the conditions leading to induction and caesarean section rates, low Apgar scores, admissions to SCBU, or the favourability of the cervix before induction. Among those who intended to breast feed fewer infants in the spontaneous group changed from breast to bottle while in hospital and after discharge from hospital than in the combined induction groups. Success in breast-feeding was not significantly associated with method of delivery or whether the infant was admitted to SCBU or not.

*** This from a 1997 study (Ann Pharmacother 1997 Nov;31(11):1391-3: Vaginal misoprostol for term labor induction. Bauer TA, Brown DL, Chai LK, School of Pharmacy, University of the Pacific, Stockton, CA, USA.)

"Despite the success of misoprostol in clinical trials, it is not approved for this indication, and the manufacturer of Cytotec does not plan to pursue approval. Therefore, independent, large-scale studies are warranted to more accurately assess the efficacy and overall safety of using intravaginal alprostadil for cervical ripening and labor induction. Additional clinical experience should also help to determine the best regimen and method of administration."

In other words, there the safety and efficacy of cytotec hasn't been sufficiently studied.

***

Lastly, on Pitocin... and here is where Dr. McIntosh and I disagree. I will have to defer to him that the molecular structure of Pitocin and natural oxytocin is the same, here is a comment from Dr. Michel Odent (researcher):

Michele Odent says that another big difference between oxytocin and pitocin is that the body releases oxytocin in bursts, while pitocin is constantly released into the bloodstream.

Therefore, the body never gets a chance to rest between bursts, because there are no bursts with Pitocin..it's just a continuous stream."

I hope this helps. Again, I admire your willingness to ask questions and look at different viewpoints!

--
Amy
Provisional Birthworks Childbirth Educator
Provisional Birthworks Doula

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