Cytotec (misoprostol) is sometimes used off-label in obstetrics to induce labor and ripen the cervix. However, it is not FDA approved or recommended for these uses in pregnant women.

This article reviews the evidence on Cytotec for cervical ripening and labor induction along with important safety concerns.

What is Cytotec?

Cytotec contains the active ingredient misoprostol, which is a synthetic prostaglandin E1 analog. It was originally approved for preventing stomach ulcers.

By increasing prostaglandin levels, Cytotec stimulates uterine contractions similar to natural labor. This property has led to its off-label use in obstetrics.

However, Cytotec is not FDA approved for inducing labor or any uses in pregnant women. It does not have the same safety profile as dinoprostone and other prostaglandins designed for pregnancy.

How Cytotec Induces Labor

When given vaginally, Cytotec mimics natural prostaglandin E2 in the cervix and uterus. This effects labor induction in two ways:

1. Cervical ripening

• Prostaglandins soften and thin out the cervix (cervical effacement)
• They also dilate the cervix (cervical dilation)

Together, these effects prepare the cervix for delivery.

2. Uterine contractions

• Prostaglandins trigger contractions of the uterine muscle
• This stimulates the laboring process and pushes the baby down the birth canal
• Contractions continue until the baby is delivered

Through these mechanisms, original Cytotec helps “induce” or artificially start labor. However, the risks often outweigh the benefits.

Effectiveness for Labor Induction

Multiple studies have compared Cytotec to other prostaglandins for inducing labor. Key findings on effectiveness:

• Cytotec results in vaginal delivery within 24 hours in 40-60% of women induced.
• It requires less additional oxytocin for labor stimulation compared to other prostaglandins.
• However, it has higher rates of uterine tachysystole (excessive contractions).
• Dinoprostone and other prostaglandins have better efficacy and safety profiles.

So while Cytotec is moderately effective at jump-starting labor, it has concerning side effects. It also does not work as well as prostaglandins designed specifically for pregnancy.

Safety Concerns and Risks

Cytotec use for labor induction has been associated with the following risks:

• Uterine rupture – Greatest risk in women with prior cesarean deliveries
• Uterine hyperstimulation – Excessive contractions that distress the fetus
• Meconium passage – Fetal bowel movement in the amniotic fluid
• Postpartum hemorrhage – Heavy bleeding after birth
• Abnormal fetal heart rate – Concerning heart rhythms leading to fetal distress
• Neonatal hypoxia – Lack of oxygen to the baby
• Admission to the NICU – Higher rate of neonatal intensive care

These adverse effects likely occur due to the relatively short half-life and potent effects of misoprostol on uterine contractions compared to other prostaglandins.

Is Cytotec Recommended for Labor Induction?

Most experts advise against the use of Cytotec for inducing labor or cervical ripening.

The American College of Obstetricians and Gynecologists states that Cytotec should not be used for labor induction, especially in women with prior cesarean deliveries due to the risk of uterine rupture.

Safer prostaglandin options for pregnant women include dinoprostone vaginal inserts and gels. These are FDA approved for induction when medically appropriate.

Oxytocin is also recommended over Cytotec when induction is warranted near or after term. Cytotec should be avoided unless no alternatives are available.

Contraindications During Pregnancy

Cytotec is contraindicated in pregnancy and should not be used without medical necessity in the following situations:

• Before week 37 of gestation when induction is not medically indicated
• In women planning a vaginal birth after cesarean (VBAC)
• With a history of difficult labor or uterine surgery
• With cephalopelvic disproportion or other risks for difficult vaginal delivery
• With fetal malpresentation (breech, transverse lie, etc.)
• With unexplained vaginal bleeding or placental issues
• With fetal distress or abnormalities

The risks clearly outweigh any benefits of Cytotec in these scenarios.

Alternatives to Cytotec for Labor Induction

Instead of Cytotec, the following methods may be used for induction when medically warranted:

• Oxytocin (Pitocin) or other IV fluids
• Dinoprostone or other prostaglandin vaginal inserts
• Mechanical dilation with a Foley catheter balloon
• Amniotomy – Artificial rupturing of membranes
• Membrane stripping – Separating the amniotic sac
• Extra nipple stimulation to trigger oxytocin
• Movement and walking to encourage labor

Non-medical induction techniques include acupuncture, castor oil, spicy foods, and certain herbal remedies. Always discuss choices with your obstetrician.

Warnings if Using Cytotec

If Cytotec is used for induction, these precautions are advised:

• Continuous fetal monitoring throughout labor
• Avoid repeated doses if inadequate response
• Do not use if placenta covers the cervix (placenta previa)
• Conduct vaginal exams carefully due to bleeding risk
• Watch for signs of uterine rupture and fetal distress
• Prepare for prompt C-section if complications arise

Having emergency plans and surgical backup is critical. Cytotec makes complications more likely.

Conclusion

Cytotec is sometimes used off-label to induce labor and ripen the cervix. However, it carries significant risks like uterine rupture and fetal distress. Other prostaglandins have better safety and efficacy profiles. Unless no alternatives are available, Cytotec should be avoided for induction due to concerns during pregnancy.

Frequently Asked Questions

How does Cytotec work to induce labor?

It ripens the cervix and stimulates uterine contractions similar to natural prostaglandins in the body. However, it is less targeted than pregnancy-specific prostaglandins.

Is Cytotec safe for labor induction?

No, Cytotec has risks like uterine rupture, especially in women with prior c-sections. It is not FDA approved or recommended for inducing labor.

Can Cytotec be used if my water broke?

No, avoid Cytotec if your water breaks before labor starts. It increases the risk of serious uterine infection in this scenario.

When would Cytotec be used for induction?

It may be used off-label as a very last resort when medically necessary and no safer options are available. This is rare.

How long after taking Cytotec does labor start?

Onset of uterine contractions typically begins within 30-60 minutes. But it can take 6-12 hours for active labor to become established.

What are signs of complications from Cytotec?

Seek medical help for excessive bleeding, severe pain, fever, foul-smelling discharge, uterine cramping, or fetal distress signals.

How often can Cytotec doses be repeated?

Do not exceed 2-3 vaginal doses. Repeated dosing without cervical change significantly raises risk of complications.

Can Cytotec be used with an epidural?

Yes but the epidural may slow labor progression. Closer monitoring is needed for uterine tachysystole and other adverse effects.

Is Cytotec used after birth?

Sometimes, in low doses, to prevent postpartum hemorrhage by encouraging uterine contractions.