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Making an informed choice: Cytotec[R] for induction.

Article Excerpt
Editor's Note: On November 30, 2004, Cytotec[R] was featured on the CBS Evening News with Dan Rather. The short piece focused on a family who had a four-year-old daughter whose birth was induced using Cytotec[R]. The mother experienced a uterine rupture and the little girl has cerebral palsy and mental retardation as a result. Several physicians were interviewed, including Marsden Wagner. The family was angry that they had not been informed that there were any risks associated with using Cytotec[R] for induction and CBS did a good job bringing out the issue of informed consent.

The practice of inducing labor has been a part of obstetrics in industrialized nations for generations. With the medicalization of childbirth came the standard of artificially initiating labor by the forty-second week of pregnancy if labor had not begun on its own by that time. Within the past decade, patience seems to have waned, potential risks of prolonging pregnancy beyond the 41st week have been studied, and women are now encouraged more frequently to induce labor by the 41st week of pregnancy (or earlier) if they have not already birthed their baby.

Up until the mid 1990s, the medications most commonly used to ripen a woman's cervix, thereby enabling the cervix to dilate more effectively with contractions, were Prepidil[R] and Cervidil[R], both category C (not proven safe or unsafe for pregnancy) prostaglandin E2 gels. Both of these prostaglandin gels have been used with varied success.

Over the past decade, a different prostaglandin has become more widely used to ripen a woman's cervix and to initiate labor. Misoprostol, more commonly known...