Can labor drugs such as Pitocin and Cytotec cause hypoxic-ischemic encephalopathy (HIE)?

Pitocin (synthetic oxytocin) and Cytotec (synthetic prostaglandin) are used to speed up the process of labor. Both of these drugs can cause a condition called uterine hyperstimulation (alternative terms include tachysystole and hypertonus).  Hyperstimulation occurs when these drugs cause contractions to be too frequent, strong, or long-lasting.  When the placenta and uterus are under continuous pressure from contractions, the vessels are also under pressure.  The pressure impinges on the vessels and makes it hard for the blood to flow from the placenta to the umbilical cord and baby.  When insufficient oxygen-rich blood is reaching the baby, the baby can become oxygen deprived, causing permanent brain damage known as hypoxic-ischemic encephalopathy (HIE). HIE can cause many other brain problems, including cerebral palsy, intraventricular hemorrhages that lead to hydrocephalus, and developmental delays.


Pitocin can be dangerous; in 2009, the Institute for Safe Medication Practices added it to its list of “high alert medications,” a distinction reserved for only 11 other drugs.  In fact, Pitocin is the drug most commonly associated with preventable adverse events during childbirth.  Research shows that Pitocin’s dose-related effects can cause contractions to be less than 2-3 minutes apart, which will cause the baby’s oxygen saturation to progressively decrease.

Cytotec is not even approved by the Food and Drug Administration (FDA) for labor induction use.  Cytotec was researched, developed, and approved for use as a drug to treat stomach ulcers. This is the only approved use of Cytotec.  The manufacturer of Cytotec (Searle) never conducted clinical research to test the safety and outcome for the use of Cytotec as a labor induction agent. Both Searle and the FDA have issued warnings to doctors regarding Cytotec’s use for off-label labor induction. Furthermore, the dosage and method of Cytotec administration raises additional safety concerns.  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 pregnant woman and baby is different, however, and there is no way to predict how they will tolerate Cytotec.  Unfortunately, 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.

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, which in turn can 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. This is an obstetrical emergency requiring an emergency C-section.

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).

Award-Winning Hypoxic-Ischemic Encephalopathy (HIE) Lawyers

hypoxic ischemic encephalopathy (HIE) lawyers - Jesse ReiterThe award-winning hypoxic-ischemic encephalopathy lawyers at Reiter & Walsh ABC Law Centers have decades of experience helping Michigan families with Pitocin, Cytotec, and HIE cases.  If your labor was induced using Pitocin or Cytotec and your child has been diagnosed with HIE or other permanent disabilities, we can help. We have been helping children affected by HIE for over three decades and are very skilled at handling the complex issues involved with infant medical malpractice cases. Please reach out today for a free review. We charge nothing unless we win your case.

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Related Resources

Video: Hypoxic Ischemic Encephalopathy Lawyers Discuss HIE, Pitocin, and Cytotec

In this video, hypoxic ischemic encephalopathy (HIE) lawyers Jesse Reiter and Rebecca Walsh discuss the causes of HIE, which include misuse of Pitocin and Cytotec and a delayed delivery when the baby is in distress.