Misoprostol (Cytotec) to Induce Labor
- purpose011194
- Mar 4, 2024
- 3 min read
Updated: Apr 6, 2024
WHY THE MEDICAL TEAM MAY SUGGEST INDUCTION?
Induction of labor is indicated when the risk of continuing the pregnancy outweighs the risks of labor induction and delivery for the birthing parent or the fetus. Examples of more urgent reasons for induction include preeclampsia at 37 weeks or more, chorioamnionitis, significant illness during pregnancy that is unresponsive to treatment, suspected fetal compromise, and term pre-labor rupture of membranes (PROM) with maternal group B streptococcus colonization.
Labor induction increases the risk of caesarean section and surgical vaginal delivery, chorioamnionitis, cord prolapse with artificial rupture of membranes, and uterine rupture in scarred and unscarred uteri. Even though undergoing labor induction, some may also fail to achieve labor.
In Canada misoprostol is utilized for termination of intrauterine pregnancy with a gestational age of 63 days or less, in combination with mifepristone. However, the drug is not approved to induce labor due to serious adverse effects such as fever, chills, vomiting, diarrhea, and uterine rupture. Cytotec was originally an FDA approved ulcer medication in the USA. Today, in the United States misoprostol (Cytotec) is FDA approved as an ulcer medication and for medical abortion. It is not FDA approved for use in pregnancy.
The labelling clearly displays a pregnant women enclosed in a circle with a slash line through it. If your doctor induces labor by administering misoprostol, you should have been warned of the risks so that you could give your informed consent. There are other drugs/options which are known to be safe. Misoprostol is not FDA approved for use in pregnancy.
HOW IS MISOPROSTOL ADMINISTERED?
The usual dose is 50 mcg orally or 25 mcg vaginally, which may be repeated every 4 hours if contractions are absent or not painful. You will be given a pill to place under your tongue (sublingual) - or - between your cheek and gums (buccal) to dissolve. Your RN or OB may instruct you to empty your bladder prior to inserting the pill vaginally near the cervix. She/he may ask you to remain in bed for at least 30 minutes to allow the tablet(s) to dissolve after placement.
Many patients choose to take the medication vaginally to induce labor because this option allows expectant moms access to meals and/or light snacks. This depends on the hospital's policy. However, please be advised that the medical team may ask that you not drink or eat once labor starts, because your risk for c-section may increase. The decision to eat or fast is yours.
WHY THEY ASK YOU NOT TO EAT?
During a c-section stomach contents can regurgitate up the gullet into the wind pipe and enter the lungs when there is no cough reflex, e.g. during general anesthesia. Solid food can block airways and cause breathing difficulties. The acidic liquid from the stomach can damage the lungs. This is called aspiration pneumonitis or Mendelson’s syndrome. It can lead to serious illness or even death. Many caesarean sections now are undertaken using epidural or spinal anesthesia, and here the risk is much lower because the woman stays awake and the cough reflex remains intact.
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IN OTHER NEWS:
2023 | Last April, Gov. Gavin Newsom announced the state spent $100,000 to buy the medication after access to another abortion drug, mifepristone, was put in legal jeopardy by a Texas district judge’s ruling.
The court sided with anti-abortion rights groups that sued the Food and Drug Administration over its approval of the abortion pill, mifepristone. The judge issued a ruling that would invalidate the drug's approval nationwide. However, a district judge in Washington state issued a contrary ruling on the same day, preserving access to the pills in certain states.
The legal back and forth put medication abortion in the national spotlight, and blue state governors, including Newsom, announced they would stockpile pills in anticipation of further restrictions as the case escalated to a federal appeals court.
Expecting demand to soar, California providers said they’d switch to misoprostol-only abortions. Usually, medication abortions consist of a two-drug protocol used to end pregnancies in the first trimester but misoprostol can be used on its own — a method data show is slightly less effective at terminating a pregnancy than the combination regimen.
The Governor’s Office said the stockpile of misoprostol was aimed at “ensure[ing] that California remains a safe haven for safe, affordable, and accessible reproductive care.”
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content is for informational and educational purposes and does not constitute medical advice
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