Cytotec / Cervadil

[docoNY]

my doc is planning on inducing me next week on the 8th (my due date) because of my bp (creeping up but everything else is ok so far and being watched like a hawk)

She mentioned Cytotec and Cervadil and I remember from WC that Cytotec was bad news. I can't find the stuff I was reading before the WC change and wanted to re-read it before I see her again on Tue and also have DH read it so he understands why he has to back me up.

I am going to google Cytotec now but if anyone has any info I would appreciate that too! prefer to be over informed! :)

[adoredh]

Hope this helps:

Cytotec's only FDA-approved use is treating ulcers. In August 2000, Searle, Cytotec's manufacturer, sent physicians a letter reminding them that Cytotec was not approved for use as a cervical ripening agent and that it was contraindicated for use in pregnancy (14). The letter listed serious adverse effects associated with using Cytotec, including maternal or fetal death, uterine rupture, and severe vaginal bleeding and shock.

[Sarah]

http://www.fda.gov/cder/drug/infopage/misoprostol/default.htm

"This Patient Information Sheet is for pregnant women who may receive misoprostol to soften their cervix or induce contractions to begin labor. Misoprostol is sometimes used to decrease blood loss after delivery of a baby. These uses are not approved by the FDA. No company has sent the FDA scientific proof that misoprostol is safe and effective for these uses.

There can be serious side effects, including a torn uterus (womb), when misoprostol is used for labor and delivery. A torn uterus may result in severe bleeding, having the uterus removed (hysterectomy), and death of the mother or baby. These side effects are more likely in women who have had previous uterine surgery, a previous Cesarean delivery (C-section), or several previous births. "

[BTB]

Searle, Cytotec's manufacturer, sent physicians a letter reminding them that Cytotec was not approved for use as a cervical ripening agent

These uses are not approved by the FDA. No company has sent the FDA scientific proof that misoprostol is safe and effective for these uses.

Just an FYI that in your discussion with your physician, this point (FDA approval) is unlikely to impress her as doctors are not limited to prescribing for FDA-approved purposes. A licensed physician is legally authorized to prescribe any approved, non-scheduled drug to any patient for any indication, whether it was the indication listed on the drug application or not. The FDA approval game is an expensive one, and many companies don't bother seeking a second drug application for subsequent indications. It doesn't mean studies haven't been done and scientific proof isn't available, it literally means "no one sent it to the FDA" since to do so ain't cheap. It's unfair, as consumers often take FDA drug aps or lack thereof as indications of safety and reliability, but it's economics.

Not to say cytotec doesn't have it's risks, only to say that harping on non-approval is fruitless.

In the second quote, the second sentence simply states what it means for the first to be true.

In the first quote, that is a CYA move on the part of the manufacturer.

Best of luck with your delivery. :)

[Sarah]

BTB- I know you're a doctor, but this drug has been linked to maternal death many times. It's not just the fact that the manufacturer advises against using it off-label, it's why they do so. It's dangerous.

[Katie&Micah]

I saw something on a news show a few weeks about cytotec. I guess the reason it's used so much is because that it's soooo incredibly cheap. But I personally think all the risks associated with it definately outweigh the $$$ savings.

I could be wrong.. but isn't misoprostol also used for abortions? I read something a while back about a teenager taking misoprostol (I'm 99% sure that's what it was) to end her pregnancy and ended up bleeding to death.

I personally think I'd steer clear of anything that the manufacturer says is definately not for pregnant women. Sure they could be saying it just because they don't want to deal with the lawsuits and other problems that could be created due to it causing problems.. but it seems that there has been a connection with Cytotec and women hemmoraging as well as mother and baby dying. You've got other options.. better to be safe imo.

[BTB]

BTB- I know you're a doctor, but this drug has been linked to maternal death many times. It's not just the fact that the manufacturer advises against using it off-label, it's why they do so. It's dangerous.

Sarah, rest assured I'm very familiar with misoprostol, it's effects and risks. You'll notice I didn't advise for or against the use of Cytotec, it's not my place to do so for someone who is not under my care. The point of my post was only to debunk the idea that there's anything unusual, unethical, or "fishy" about off-label drug prescription - it says far more about the pocketbook than about the evidence for or against a drug, and most people don't realize that.

[BTB]

Katie, yes, prostaglandins can be used to induce abortion.

I personally think I'd steer clear of anything that the manufacturer says is definately not for pregnant women.

The progesterone supplements I took throughout my pregnancy came with neon orange warning labels not to take it while pregnant. The diflucan tablets I've been taking to fight thrush due to breastfeeding specifically state in equally direct terms not to take while nursing. There is no middle ground, companies either certify a drug as safe for pregnancy and lactation (and take on all the liability that implies) or strongly recommend against it's use. Since pregnant women are nearly always excluded from drug trials, the latter is the norm. Look at your vitamin bottle - it will warn you to check with a doctor before taking them if you're pregnant or nursing.

[kakirk]

While I'm not a fan of Cytotec (even having been the recipient of it when I lost my first twins), there are A LOT of drugs prescribed for off-label use, and often in pregnancy/family planning places.

Specifically, Glucophage/metformin comes to mind -- used to control insulin resistance/diabetes, and is often prescribed for those of us with PCOS.

Also, Lupron is often used in IVF cycles -- I think this is another drug whose FDA approval is for ulcer treatment, but is regularly used in IVF cycles (and I've been on it twice).

I think the risks of Cytotec are real, and it should be avoided (my personal opinion), but I have to agree with BTB on this one that avoiding it only because it's not FDA approved for pregnancy isn't a strong argument, IMO. I'd stick more to the risks that have been documented (like maternal death, as Sarah points out).

Katie

[linda_loo]

When I had my first child (2002), Cytotec-talk was all the rage, and most of it was about horror stories. When I had my 2nd (late 2003), there was more information out there. I remember reading a bunch of articles and overwhelmingly, I found that most of the horror stories are from the early use of C for induction. At that time, there was a lot of disagreement about doseage guidelines and the horror stories were a result of too much C.

If you do some googling for current articles, you might find some more of this information.

[mamacita]

I'll tell one of the horror stories. A good friend of ours, whose dd was born 2 weeks after ours, was induced with Cytotec (due to supposed large fetal size-- but that's a whole other issue). Cytotec is administered by placing a portion of a pill at the cervix-- once it's been placed, it cannot be removed effectively (contrast pitocin in an IV, which can be turned off immediately). Our friend was one of the "rare" cases where the Cytotec caused uterine hyperstimulation. To be fair, she also wasn't monitored carefully enough, but the eventual result of her Cytotec induction was uterine hemmorage and an emergency c/s and hysterectomy. She nearly died and was considerably disabled and unable to care for her daughter by herself for the first year. Now, nearly 4 years later, she continues to have medical issues related to the delivery.

Cytotec does have appropriate uses-- even in the obstetric context. For instance, it can be used without significant risk to induce contractions after delivery if the placenta doesn't detach (and when the uterus isn't already stretched/stressed so much). And it's certainly effective to induce labor-- it's just that when it goes wrong, it goes very, very wrong. I would stay very far away from it.

[Delta]

Just ask them not to use it because you do not feel comfortable with it. Period.

Besides, why the need to use it when there are other things out there that do the same thing?

[docoNY]

thanks ladies for all the info and I will definitely say I do not want it used on me when I talk to my doc on Tue.

hope everyone has a great holiday weekend!!

[myshel]

I just got back from my 40 week OB appointment (I'm actually 40 weeks, 1 day). Since I'm locked up tight with virtually no dialation, effacing, or thinning, the dr has decided to give me Cervadil at 41 weeks with a pitocin induction the next morning if the Cervadil doesn't start labor on its own.

I'm looking to hear from anyone who's had an experience with Cervadil or this type of induction. I haven't really found a lot of the web regarding Cervadil except for a few horror stories.

TIA!

[Audrey&Jackie]

I too was scheduled for Cervadil/Pitocin four days after my due date. I had gestational diabetes and they were worried about Meredith being too large (she wasn't) and general placenta breakdown.

In my research, I found out that Cervadil is not the same thing as Cytotec. I don't remember all the particulars, but I do know that Cytotec has many horror stories associated with it. Now, there are other reasons why some don't like inductions (higher rate of c-section associated with it, for one) but Cervadil doesn't have anything to do with that in and of itself.

As it turns out, when I went in the night before for my Cervadil I was already dilated 3 cm. They let me go back home and then check in the next day for the Pitocin. My contractions were severe almost immediately (not that I have anything to compare them too, but I believe they were the horrible, severe contractions associated with Pitocin). I got an epidural pretty quickly and delivered (vaginally) at 4 in the afternoon (labor was induced around 9:30am).

HTH

[myshel]

Thank you for your response. I was getting worried that no one would respond. No one I know IRL has ever had to be induced. In fact, my mom and sister went early so no one can offer me advice.

Thanks for sharing your story!

[BTB]

I hope you won't mind if I share my Pitocin experience, since if you're talking Cervidil you'll probably get it too.

I was terrified of pitocin, even raised a big stink insisting they wrap my IV arm in plastic so I could take a shower before starting the Pit, convinced once it began I'd be stuck in bed, wracked with pain. I was on it a total of 17 hours, no epidural, and it was okay. My Pit drip was turned high enough that I did have an episode of uterine hyperstimulation, and had to be given terbutaline, which reversed that almost immediately - so it's not like it wasn't working! Still I had such little progress I got an IUPC and with contractions past 100 montevideo units, I still was doing fine working with the doula on breathing and relaxing. I even sat on a birthing ball next to the bed for some time.

It is terribly painful for some women, but not all. Now second stage labor - that was a whole 'nother story, but I won't go there. :)

[BTB]

P.S. The original question: :o

Cervidil use has a much better safety record than Cytotec, and a lower complication rate than c-section, so it's worth a chance if avoiding surgery is a goal if possible.

All the best, and congrats a tad early. :D

[Adam's Pi]

I was 38 weeks and DS was out of room. I was 1 cm dilated and 70%(??) effaced. I had cervadil the night before and Pitocin the next morning. With the cervadil, they put it right on your cervix and ask that you limit your activity (probably why they do it at night). I was only up to use the restroom, then went to sleep. The next morning I woke up feeling cramps (like AF cramps). I got up to go to the bathroom, wiped, and holy moly--there was my mucus plug. As I was standing up, my water broke. I waddled back to the bed, pushed the nurse's button, and the contractions started on their own.

I was given Pitocin (still not 100% sure why--I came in having contractions, they intensified after my water broke). I labored for 12 hours but never progressed past 6cm. I was able to breathe/rock/walk through the contractions for a better part of that 12 hours. The epidural was awfully nice, though. I did end up with a c-section. After discussing it with my ob, the consensus was that I would've ended up with one anyways, due to the size of my DS (big head, small pelvis for me). I hope I'm assuming correctly that the cervadil/Pitocin had little effect on that outcome.

[wagsgirl]

For me, Cervadil only helped efface me to 50%. I was induced at 36w2d with my daughter because my bp shot up. It wasn't a bad experience with it and after I was effaced to 50%, they started the pitocin, but it just didn't help and I ended up with a c-section at 36w3d. I went in with no effacement and no dilation, well, a fingertip, but that's nothing. It ended with 50% effaced and no dilation.

That post is totally written really screwy, but I hope you get the jist.

I hope you have a great experience with the cervadil/pitocin combo! Good luck!!! :)

[ButterflyJen]

I was induced with Cervadil (due to IUGR/DD's failure to grow inside). They inserted it around 7:30 PM and I started having contractions pretty much right away (not painful, just tightening, and I could see it on the readout next to my bed). They checked me the next morning and I was doing pretty well by then on my own (so nothing else was needed at that time).

Long story short, the Cervadil wasn't bad. It helped get me going. (After that, things kind of spiraled downward, but the Cervadil was OK!)

[kerrykate]

I was induced and had to go to the hospital the night before so they could insert the cervadil. I wasn't effaced at all and dialated to maybe 1-2. The nurse put the cervadil in twice, once at 9pm and again at 1:30am. It really didn't do anything for me. Pitocin was started at 7am, I had a long slow progressing labor and didn't even really start to dialate and thin out until that evening. DD was born the following morning at 6am.

[elly]

I wasn't effaced or dilated at 40 weeks so I was given cervadil at night (stayed in the hospital). I think they gave me an Ambien which helped me sleep a few hours...otherwise I wouldn't have slept at all due to excitement. (it's so important to get sleep while you can!!) I really never had any pain and while it helped soften things a little, it did not help me dialate at all. Since I was only 40 weeks, I choose to go home and wait a week to see if my dd would come on her own. At 41 weeks, I was still nothing......this time I was given cytotec, which only helped a tiny bit. With cytotec, the contractions started but they had to use a baloon in order for me to dilate.....I didn't like the sound of this but it did not hurt and quickly helped me get to a 4. :) I ended up being stuck at a 4 and eventually had a c section which i was very thankful for at the time. i was ready to meet my baby girl. i hope everything goes well for you!! :)

[myshel]

Thanks for all of the replies again. Also, I feel like a doof; I spelled Cervidil wrong. Please don't hold it against me. It's pregnancy brain, I swear.

I appreciate hearing all of your experiences. DH is supportive of the situation but my sister has sent me several emails about the negative effects of Cervidil and Pitocin, so I've been a bit unsure. Of course, she is completely against any sort of medicated birth with an OB in a birthing center so... but that's a different story.

Thanks again for sharing.

[SarahKatG]

I was induced with Cervadil when I was a fingertip dialated and 75% effaced. They put it in at 8pm and checked it at 8am. There was no progress. The doctor decided to do another 12 hour round of it at noon. This time she inserted it and pushed it waaay the heck up there. This got my contractions going immediately. By 6pm I was 4cm. I had an epidural at 9:30pm when I was 7cm. She was born at 12:28am with just 30 minutes of pushing. My labor went fast once it got going. I never needed the Pitocin.

Good luck with your labor! I was nervous too after reading about how Pit can make contractions more intense. I was grateful that the Cervadil was all I needed.

[BrownEyedGirl]

I'm being induced on Friday and I wanted to get opinions on the two drugs for ripening the cervix.

I've heard bad things about both, and I just want to get more opinions.

I need to figure out which I want by Thursday so I can let the doc know where I stand.

Thanks.

[ellidew]

I wasn't given an option (er, didn't know there was an option to consider). I was given cervidil and didn't have any problems with it. I contracted through the night. After having it in for 12 hours they took it out and i took a shower and then they started the pitocin. I guess i don't have anything exciting to say about it. There's always risk...

[janders6]

I would opt against cytotec. Its been known to cause uterine rupture.

[Lisa]

I was given cervidil and didn't have any problems with it. After having it in for 12 hours they took it out and i took a shower and then they started the pitocin. I guess i don't have anything exciting to say about it.

This was almost my exact experience with DS


I would opt against cytotec. Its been known to cause uterine rupture.

I've heard the same. Have you googled it?

[Toonces]

Here are a couple of threads that might help you:

Cervadil thread (http://www.constantchatter.com/forum/showthread.php?t=2538&)
Cytotec thread (http://www.constantchatter.com/forum/showthread.php?t=1221&)

There's also quite a bit of discussion about both on MDC.

[L-O-V-E]

I would stay far far away from Cytotec!!! It is not approved for use in the induction of pregnant women. It is supposed to be used to treat ulcers. Many doctors do use it because it is cheap and is effective in stimulating the uterus.

However, some of the major concerns with this drug are:
1. Since it is not approved for induction, doctors don't have a set guideline on how much to give. It is at their discresion. Also, the pills come in a certain dosage and have to be halved and quartered before administration, so you are never sure of exactly how much you are getting.
2. Since this is a pill form, once you take it, there is no turning back. I believe some doctors do insert it vaginally however. But unlike pitocin which can be turned down in the dosage is too high, once you take the pill, that is it.
3. There is no disputing that cytotec stimulates the uterus and starts contractions. However, it often has led to hyperstimulation resulting in drops in fetal heart rates and uterine ruptures.

I don't mean to be an alarmist, but I have done lots of reading on this topic and it is scary. For more information, try to get your hands on a copy of "Born in the USA" by Marsden Wagner. He was an ob/gyn for years, and worked for the WHO for 14 years and talks about cytotec in this book a lot.
Here's a link (http://www.midwiferytoday.com/cytotec/)for more online reading on this....

I do wish you the very best with your upcoming birth.

~Lori

[Alanna]

i had cervidil and i started into labor because of it about 7 hours after it was inserted... (i ended up getting an epidural though.. and then labor slowed so i got pitocin anyway....)

if faced with induction again - i would probably go that route again...

[mimieliza]

If I had it to do over again (which I will not since I'll now be having repeat c-sections) I would have avoided Cytotec. But NOT for the following reasons:

-Off label usage - this is totally standard practice for docs, as pointed out by BTB above

-Risk of uterine rupture - this is most frequently associated with Cytotec usage in VBAC patients, which is no longer used, high dosages, and inadequate monitoring. I was given very low dosage and monitored continuously.


The reason I would avoid it is that I feel it did lead to uterine hyperstimulation, which led to fetal distress and a c-section. I started having contractions without a break - they would last for five minutes. I needed an epi very early to deal with this, and eventually DD's heart rate dropped seriously and did not recover, which is when the c-section took place.

I wish I had pushed harder for cervidil.

[docoNY]

just to update my own thread from 2 yrs ago :)
I was given Cervadil and I actually 'took' off after a few hrs of it.. it was inserted around 2p and had it removed around 8ish and my epidural around 9ish and I was ready to push at 12m - I never needed pitocin and dd was born 220a on 7/9 2 yrs ago yesterday :)

good luck with your upcoming birth!

[RobynScott]

This thread is so timely for me! I skimmed it quickly today (not thinking much of it) then at my drs. appt tonight - wham - my dr. put me on the schedule for an induction at 41 weeks and said they would be using cytotec. When I asked, she said it is much more effective than cervadil. I think I need to discuss further with her - she's really pushing the cytotec but I'm concerned after reading this thread. Off to check out the links ...

[BrownEyedGirl]

Robyn, looks like we are in the same boat. Cervidil just seems so much more friendly of an option. At my last appointment she said she'd use Cervidil then when they called to confirm my induction they said Cytotec...I asked why the change and they said nothing was written in stone and I could talk to her about it at my next appointment. So I'm really hoping that she's okay with either and will just let me choose.

You just don't hear as much bad stuff about the Cervidil. I'm sure either will be fine, but I'm going to hope to avoid Cytotec.

[ruby]

I had Cervidil for both my deliveries. Worked well and my water broke about 4 hours after insertion with the first boy, did nothing for the second delivery, but no ill effects either time. I would definitely go for the less controversial and safer drug.........

[Peever]

I was given cytotec orally to induce contractions after my water broke and I failed to have any and they were unable to get an IV in after many attempts.

Nothing bad happened per se, there was meconium present during the delivery and I don't know if that would have been a problem if I had not been induced, but if the same situation should arise this time, I won't take it. The contractions were really horrible and there was no way to back them off like you would with pitocin because it was a pill vs. an IV. I didn't have it for cervix ripening so I can't comment there, but overall I'd avoid it.

[jessmaine]

I was given Cytotec vaginally and it was a terrible experience. I had high BP so they induced my a week early. I was not dilated at all. At 9 am they gave me the first dose and I had the baby at 11:30. It was a horrible labor. It brought on the WORST most painful contractions. I was in agony. This was my second child so I could tell the difference between regular contractions and these. I would NEVER get in again.

[karlatta]

I just came back from my OB appointment and my doctor mentioned inducing next week (at just over 40 weeks) with Cytotec. I kind of balked, but didn't say much because I didn't remember of the specifics with Cytotec, just that it was talked about negatively here.

My cervix is ripe, so it wouldn't be for that purpose - only to stimulate uterine contractions. Did anyone take it under these conditions, and what was your experience? I have another appointment between now and the induction to discuss, but I'm already a bit worried about it.

[EmilyZA]

How do they insert the Cervadil? Is it a suppository? What exactly is it?

[mkvh]

Emily--According to http://www.birthingnaturally.net/birthplan/intervention/cervidil.html (the first site I could find), it is a pouch with a string like a tampon. However, I could have SWORN mine was a gel.

[docoNY]

Emily mine kind of looked like a tampon with a long string - I was told if I went to the bathroom to look in the toilet after to make sure it didn't fall out :D

[BrownEyedGirl]

Emily My doctor told me that it was a gel. I wouldn't know for sure since she convinced me to use cytotec.

And speaking of using cytotec, I suppose I can give an update on how my induction went. My doc was pushing cytotec pretty hard after I asked about using cervadil...I told her that she hasn't given me reason to not trust her and I went ahead with cytotec. We checked into the hospital at 6:00 on Friday. They gave me my first dose of cytotec at 7:00, then at 10:00, then at 1:00. I was having mild contractions...I couldn't even really feel them until after 1:00. At about 3:30 my water broke and the contractions started getting a bit worse. By 5:30 I was swearing like a sailor, the contractions were hurting so bad. I went from about 3 cm to over 7cm in less than two hours. I finally got my epidural at 7:00ish, things were great after that.

My doc was doing a c-section at the time I was fully dialated, so they just let me labor down since ds was still pretty high. At 11:00 my doc was back and I was ready to push...1 hr and 30 minutes later DS was born.

So, cytotec worked for me. I'm pretty sure the contractions were worse than they would have been naturally, but I don't really have anything to compare it to. All in all, it sucked, but I would do it again.

[karlatta]

I thought I should stop by and share my Cytotec experience as well.

I was induced at 40w2d for dates. (No measuring big, preeclampsia, etc.) When I arrived at the hospital, I was 2cm dilated, 90% effaced, and soft.

I had doses of Cytotec at 2am, 5:30am, and 8:30am. They skipped the final dose (around 11:30) in favor of waiting for my doctor to examine me. When the doctor came in, he was baffled as to why I wasn't progressing. I had been having contractions every 2 minutes since around 2:30am, but there was no change in my cervix.

At around 2pm, he decided to start me on Pitocin. Again, no change. I continued to have contractions every 2 minutes for the next several hours with no change in my cervix. I was told that if nothing happened by midnight, I would be sent home.

Finally, at 9:30pm (after 19 hours of unproductive contractions), my water broke. The contractions were suddenly very, very intense. I had planned to go naturally, but I asked for Stadol at that point because I was not expecting to go into labor after my long, unproductive day, and I needed a little help managing the pain. I dilated from a 2 to a 10 in around 2 hours and my daughter was born after 40 minutes of pushing. I didn't have an epidural or any other type of pain medication.