A safety review of medications used for labour induction

ABSTRACT

Introduction: Induction of labour is a commonly performed procedure around the world. There are various medications used for induction including those commonly used for cervical ripening (prostaglandins) and oxytocin. The ideal agent is one that decreases the time to achieving delivery without compromising maternal or neonatal safety. The ‘optimal safe agent’ remains undetermined.

Areas covered: This article reviews the safety of currently used induction agents. Prostaglandins and oxytocin have proven to be effective in labour induction, and their profiles will be reviewed in this article. We discuss the data that supports combining some of the agents. We also cover the safety of medications used for labour induction in setting of a scarred uterus.

Expert Opinion: There is continuous debate about the ideal induction agent: one that balances safety with efficacy. We recommend the practice that there is not one perfect agent for all, and that the clinical scenario and previous obstetric history should be considered before choosing an agent. In the future, pharmacogenomics may show that genetics may affect the individual response and adverse reactions to the various agents.

KEYWORDS:

• Labour induction
• cervical ripening
• prostaglandins
• misoprostol
• dinoprostone
• oxytocin
• Foley balloon
• drug safety

Article highlights

• Prostaglandins are suggested for cervical ripening.

• Oxytocin should be used in setting of labour induction.

• Tachysystole and increase cesarean rates are the two primary safety concerns with these agents, but there is sufficient data that when used per established protocols, they are safe agents to use.

• In setting of TOLAC, oxytocin can be used with proper counseling, but prostaglandins should be avoided.

• Consideration can be given to combination methods of Foley with misoprostol or Foley with oxytocin with the caveat that these are not well studied methods in all populations

• A large randomized trial to properly compare these agents and assess the efficacy, safety and patient satisfaction is needed

This box summarizes key points contained in the article.

Declaration of interest

DA Wing has been a consultant for Ferring Pharmaceuticals, Inc; prior to that she received research support for the conduct of this trial. She has attended an advisory board as a panel member, received support for travel to a FDA meeting on behalf of the sponsor, to present research findings at a major international scientific congress and to advise the sponsor in a global obstetrics advisory council.

Additional information

Funding

This paper has not been funded.