Why is Cytotec Being Used?
Cytotec is no more effective, and much less safe than Prepidil or Cervidil ( prostaglandin E2), another agent used in the hope of reducing the cesarean rate in labors induced with an unripe cervix. An analysis of 16 trials, in which women were randomly assigned to receive either Cytotec or Prepidil/Cervidil, showed similar cesarean rates (8). Two additional randomized controlled trials comparing the two, and published after the analysis, also found similar cesarean rates (10, 12). Among all 18 trials, totaling 2,550 women who received one labor induction drug or another, cesarean rates were 19 percent with Cytotec and 20 percent with Prepidil/Cervidil. As for safety, a review of 10 studies, totaling 832 VBAC women given Prepidil, reported no uterine ruptures. (4)
Cytotec's sole appeal is price. Cytotec costs pennies per induction, whereas Prepidil and Cervidil cost close to $100 per dose, and more than one dose may be needed (3). Cytotec also reduces the need for intravenous oxytocin (Pitocin), the hormone that stimulates contractions, another savings.
Cytotec for VBACs?
A search of the medical journals produced four reports describing 13 uterine ruptures following the use of Cytotec in women having induced labors after prior cesareans (3, 13, 15-16). These resulted in two hysterectomies and two deaths of babies.
In one study, eight percent of VBAC women experienced a uterine rupture, compared with 0.2 percent of VBAC women beginning labor on their own (13). These authors also searched the medical journals for other studies of Cytotec use in VBAC inductions and collected eight studies, comprising 122 VBAC women, of whom six (five percent) experienced uterine ruptures. A study published after this one added another 131 VBAC inductions with Cytotec. It reported no uterine ruptures, although its authors did found that Cytotec substantially increased the risk of placental abruption in VBAC women, compared with women with no scar. (9). Looking at these statistics, it is estimated that uterine rupture occurs in four percent of VBAC women given Cytotec. This compares with a 5 per 1000 (0.5 percent) overall rate of uterine rupture in VBAC labors (5, 7). This means that using Cytotec increases the risk of uterine rupture in women with a scarred uterus eight-fold.
It isn't clear why Cytotec appears to pose a special risk to women with uterine scars. One study's authors speculated that Cytotec may soften the connective tissue of the scar in addition to softening the connective tissue in the cervix .