The last paragraph in this section is a review of studies trying to find the correct dosage for Cytotec induction. The number of studies on Cytotec labor induction is far fewer. During a case I was involved in, I asked the obstetrician about the off-label use of Cytotec for labor induction. Cytotec induction. In ACOG’s recommendation on Cytotec induction, the organization leans heavily on a paper by A.B. Without adequate testing of Cytotec (misoprostol) for labor induction, obstetricians simply began to use it on their birthing women. He replied with the same answer that I have heard from so many clinicians: "We use Cytotec off-label for induction just like we use other drugs off-label all the time." Compare this to someone involved in a fatal car accident who is asked why he did not follow traffic laws and drove 100 miles an hour in a 25 mile an hour zone. First, in reality, using Cytotec for induction is not "off-label" at all-it is "on-label contraindicated." On the Cytotec label it is explicitly written that this drug is contraindicated for use on pregnant women.

"On-label contraindicated" is a whole different level of risk-taking than a use that is not mentioned one way or the other on the label. More so, long-term use begets its own set of worries, potentially paving the way to physical dependence. In the section titled "Induction of Labor in Women with Previous Cesarean Section," the authors review the research showing the huge increase in risk of uterine rupture in VBAC if Cytotec induction is used and correctly conclude that it should not be used in this way. How many women with VBAC were given Cytotec induction between 1990 and 1999? They never mention that the paper showing the risk of uterine rupture with Cytotec induction in VBAC was published in 1999, a decade after Cytotec induction had been used on large numbers of VBAC women. Proof of the danger of such nonevidence-based practice came in 1999, when there was enough evidence showing the danger of Cytotec use in VBAC that even ACOG came out against it.

I find no concern from ACOG or many individual obstetricians with this indisputable fact. But today, rather than using this experience to push for more evidence before use, ACOG and internist-bad-sassendorf.de some individual obstetricians are pushing for more use of Cytotec when its safety is still in serious doubt. But ACOG is not a scientific body; it is an organization of professionals-a trade union trying to protect the interests of its members. Because so many of ACOG’s members already use Cytotec induction off-label for its incredible convenience, the organization needs to support its members by recommending this practice. The authors greatly confuse the reader by lumping together all uses of Cytotec during pregnancy: first trimester medical abortion, induction of labor, postpartum hemorrhage. The paper has a section titled "Misoprostol in the Third Trimester of Pregnancy." The first part of this section is devoted to efficacy (not risk); no one is debating the effectiveness of this drug. They were taking advantage of a huge loophole in our drug regulatory system. Just about everyone in the world, after taking a careful look at the scientific evidence, has concluded we don’t yet know enough about the risks to be willing to use it.

Another problem with the excuse "we give drugs off-label all the time" is that the doctors using it are taking matters into their own hands when it comes to the use of drugs on their patients. Voltaren Joint Pain Extra Strength is specially developed with an easy open cap which flips open with the use of a thumb or finger. A second reason to be concerned with the offhand answer of some obstetricians is that all off-label use is lumped together as though there were equal risks involved. When obstetricians using Cytotec induction are confronted about their willingness to use a drug "off-label," they inevitably answer: "We use drugs off-label all the time." There are several serious problems with this answer. In this nine-page paper, there were only a few sentences about the risks of Cytotec induction. These sentences admit that the risk of adverse outcomes remains unknown. And you can’t compare the risks of Cytotec induction with the risk involved in giving other drugs to pregnant women off-label. Colonic wall associated risk of operations involving complete disruption to the continuity of the great strain.