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Problems and Hazards of
Induction of Labor

HAZARDS AND PROBLEMS OF INDUCTION AGENTS

Cytotec (Misoprostol)

Cytotec, although widely used as an induction agent, is neither formulated nor intended for use in labor. Cytotec’s manufacturer, Searle, has repudiated its off-label use as an induction/cervical ripening agent because of Cytotec’s attendant risks. (Ref. 27)

The FDA states that Cytotec’s major adverse effects include uterine hyperstimulation, which can become severe and result in profound fetal distress; uterine rupture; amniotic fluid embolism, which has a high maternal and infant mortality rate; severe genital bleeding; shock; fetal death; and maternal death. (Ref 6) Other adverse effects include retained placenta, cesarean section, and passage of meconium (the baby’s first stool) into the amniotic fluid, which can cause a type of newborn pneumonia ifinhaled. (Ref 6)

Cytotec is commonly believed to pose a life-threatening risk only in women with a uterine scar or with high doses. However, cases of maternal and infant death and hemorrhage requiring hysterectomyhave been reported in women with no uterine scar, some of whom were given a minimal dose.(Ref. 13, 28, 30)

Cytotec dosage cannot be controlled because the drug is a small pill that must be cut in pieces.

Once given, the drug cannot be rescinded or the dosage reduced in case of adverse effects.

Cytotec does not decrease cesarean rates compared with prostaglandin E2, which is FDA-approvedfor use in labor. (Ref. 16)

Cytotec’s only advantages compared with prostaglandin E2 are much reduced cost and faster labors. (Ref. 16) Both benefit only hospitals and doctors as short labors are usually intense, tumultuous, and difficult.

Prostaglandin E2 (Prepidil, Cervidil)

Prostaglandin E2 can cause uterine hyperstimulation and fetal distress. (Ref. 18) Fetal distress can require cesarean section.

Prostaglandin E2 does not reduce excess cesareans associated with labor induction. (Ref. 18)

Unless the drug is formulated in a tampon (Cervidil), the drug cannot be rescinded or the dosage reduced in case of adverse effects.

Oxytocin (Pitocin)

Complications of oxytocin (Pitocin) include uterine hyperstimulation, (Ref. 25) which can lead to fetal distress; twice the chance of the baby being born in poor condition;(Ref. 15) postpartum hemorrhage; (Ref. 25) and greater probability of newborn jaundice. (Ref. 25) Rare, severe, maternal complications include uterinerupture and water intoxication leading to coma and death. Oxytocin may also cause brain damage or death in the baby. (Ref. 25)

Next: Elective Labor Induction

Labor Induction Fact Sheet References