Can labor drugs such as Pitocin and Cytotec cause birth injuries?

A: Yes. It is common for physicians to use medications to induce or speed up labor. Pitocin and Cytotec are the most common labor induction medications. However, if misused, these drugs can cause birth injuries such as hypoxic-ischemic encephalopathy (HIE) and brain bleeds, which can lead to cerebral palsy.

Utilization of medications to start and speed up labor is a very common obstetrical practice. However, many birth injuries occur because physicians misuse these risky drugs. The nursing staff and physicians may also fail to properly monitor the mother and baby, turn down or turn off the medication, and/or perform timely and critical interventions when the mother’s contractions become excessive and the baby’s heart rate becomes abnormal, or non-reassuring. Birth injuries that can occur when labor drugs are used include cerebral palsy, hypoxic-ischemic encephalopathy (HIE), and brain bleeds.

Uterine tachysystole and oxygen deprivation

Pitocin is a drug used to induce and strengthen uterine contractions. If used improperly, Pitocin can lead to uterine tachysystole, sometimes also called hyperstimulation or hypertonus. Uterine tachysystole refers to contractions that are too long, too strong, or too frequent.

There are many vessels in the womb that carry blood from the mother to the placenta and through the umbilical cord to the baby. When a contraction occurs, these vessels are pushed on, which decreases or stops the blood flow going to the baby. When the contraction stops, blood can flow again and the placenta is recharged with oxygen-rich blood for the baby.

Excess uterine activity like frequent or strong contractions can appear on a fetal monitor strip as a series of sharp, jagged lines.

However, if contractions are too long, too strong, or too frequent, the placenta does not have enough time to recharge and can lead to low oxygen levels for the baby. At its worst, uterine tachysystole results in complete oxygen deprivation, also known as birth asphyxia. Oxygen deprivation can cause a permanent brain injury in the baby due to hypoxic-ischemic encephalopathy (HIE). Prolonged oxygen deprivation can cause the baby’s blood to become very acidic (acidosis/acidemia), which also causes cellular damage to the brain and body.

Hyperstimulation must be recognized as soon as it starts to occur, and it must be quickly and appropriately treated to avoid injury to the baby. It also is critical that the medical staff have the utmost skill in interpreting the baby’s heart rate on the fetal monitor. Waiting until the baby’s heart rate is indeterminate or abnormal to treat hyperstimulation is dangerous and negligent.

Oxytocin (Pitocin)

Oxytocin (Pitocin) is the most common drug used to induce or augment labor in the U.S. In 2007, it was listed as a “high-alert” medication by the Institute for Safe Medication Practices, meaning the drug carries a high risk of harm when improperly used and requires special safeguards to reduce the risk of error. Research shows that oxytocin increases the risk of excessive uterine activity and impairs blood flow to the baby from the placenta, which can cause birth asphyxia during labor.

Pitocin does not work well when the cervix is not ripe, and is therefore sometimes used in conjunction with Cytotec. The use of these drugs together can be especially risky. In addition to hyperstimulation, use of these drugs (either together or separately) can cause the uterus (womb) to rupture due to stress from contractions. A ruptured uterus can cause extreme bleeding in the mother, and also cut the baby off from the mother’s circulation (partially or completely) and deprive the baby of oxygen-rich blood. If the tear is at the placenta, or if there is a complete tear, the baby may be totally cut off from circulation and not get enough oxygen for too long. This is an obstetrical emergency requiring an emergency C-section.

According to ACOG, uterine tachysystole and abnormal fetal heart tracings are common when oxytocin is used. ACOG recommends that every obstetrics department develop guidelines for the preparation and administration of oxytocin by staff members who are familiar with its adverse effects and who have skill in fetal heart rate and contraction monitoring. It is emphasized by ACOG that when oxytocin is used, every effort must be made to reduce uterine activity to minimize the risk of oxygen deprivation and acidemia in the baby.

Cytotec

Oxytocin (Pitocin) and dinoprostone are approved by the Food and Drug Administration (FDA) for ripening (softening) the cervix and inducing labor. However, misoprostol (Cytotec) is only FDA approved to treat stomach ulcers. Physicians often use Cytotec ‘off-label’ to ripen the cervix and induce labor. Until 2002, the FDA listed labor induction and cervical ripening as contraindications, or reasons not to use Cytotec. In 2002, these contraindications were removed, but the FDA continues to warn physicians that using the drug can lead to adverse outcomes, including tachysystole, uterine rupture, and amniotic fluid embolism (when amniotic fluid or debris enters the mother’s blood stream and triggers a severe allergic reaction). All of these outcomes can lead to severe oxygen deprivation in the baby, HIE, and other birth injuries.

The American College of Obstetricians and Gynecologists (ACOG) agrees with experts who find that use of Cytotec for labor induction is dangerous in women who have a previous C-section scar (VBAC) or have had major uterine surgery. Cytotec is contraindicated in these instances because it puts the mother at great risk for uterine rupture.

ACOG’s position is that small doses of Cytotec may be used every 3 – 6 hours. Research shows that when too much is used (50 mcg or more in a six hour period), there is an increased risk of complications, including uterine tachysystole and abnormal fetal heart rates.

Unlike other labor induction drugs (such as Pitocin and Cervidil) Cytotec is not administered in IV form or via a removable vaginal insert. Instead, it is a pill that is inserted vaginally. The pill is typically cut into quarters, with one quarter inserted every four hours. Every patient is different, however, and there is no way to predict how they will tolerate Cytotec. If the mother or baby has an adverse reaction to the drug, it cannot be rapidly discontinued like other labor induction drugs (e.g., turning off an IV or removing an insert) since the medication is absorbed into the body.

The Bottom Line

When Pitocin or Cytotec are used, it is imperative that the physician thoroughly explain the reason for using the drugs, as well as the risks, benefits, and alternatives to their use. In addition, types of delivery (vaginal birth versus C-section) must be thoroughly explained to the mother, along with the risks and benefits of both modes of delivery. Doctors must communicate with their patients about such matters in order to obtain informed consent.

Pitocin and Cytotec have long been recognized as dangerous, and researchers have concluded that a fetus’s well-being may be in jeopardy when Pitocin-induced hyperstimulation occurs during labor. It therefore is crucial for Pitocin and Cytotec to be used conservatively and in accordance with standards of care. Careful, continuous fetal monitoring is essential. Furthermore, these labor induction drugs should only be used for non-elective, emergency induction of labor, and should never be used during a vaginal birth after C-section (VBAC).

Legal help for Pitocin and Cytotec injuries

If your labor was induced using Pitocin or Cytotec and your child has been diagnosed with a permanent disability, call the birth injury attorneys at ABC Law Centers: Birth Injury Lawyers (Reiter & Walsh, P.C.). We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future, and we give personal attention to each child and family we represent. Our firm has numerous multi-million dollar verdicts and settlements that attest to our success. Our award-winning lawyers are available 24 / 7 to speak with you, and we do not charge any fees for the entire legal process unless we win.

Sources

Center for Drug Evaluation and Research. (n.d.). Drug Safety and Availability – Misoprostol (marketed as Cytotec) Information. Retrieved September 24, 2018, from https://www.fda.gov/Drugs/DrugSafety/ucm111315.htm
Peck, Peggy. “ACOG Issues New Guidelines for Induction of Labor.” MedPage Today, MedpageToday, 21 July 2009, www.medpagetoday.org/obgyn/pregnancy/15184?vpass=1.