Generality
Medications for the induction of childbirth are administered in cases where it is necessary to intervene to induce and / or favor labor .
Clearly, these drugs can be used only and exclusively by medical personnel in the hospital setting and only in cases of real need, since they are able to cause sometimes serious side effects and since their use is certainly not without contraindications.
For these reasons, the pharmacological induction of childbirth is a medical intervention that can be implemented only when such action has greater benefits and lower risks, both for the mother and the fetus, compared to the expectation of the spontaneous beginning of labor. To be honest, this statement does not only apply to the pharmacological induction of childbirth, but is equally valid for non-pharmacological induction.
What are
What are birth induction drugs?
When we talk about drugs for the induction of childbirth we refer to a group of medicines made with active ingredients capable of stimulating and promoting uterine contractions and able to favor the maturation of the cervix, therefore the relaxation of the musculature present in this area. In this way, the aforementioned drugs are able to stimulate, induce and promote the labor of childbirth and the birth of the child.
These active ingredients can have a natural origin, or represent the synthetic analogues of molecules naturally present in the body implicated in the mechanisms that induce childbirth. In any case, the drugs in question - even if obtained synthetically - are all capable of mimicking the effects of endogenous molecules involved in the spontaneous onset of labor.
Therapeutic indications
When can the drugs for birth induction be used?
The indications of use of drugs for the induction of childbirth concern all those cases in which it is necessary to intervene inducing labor, both to safeguard the health of the child and to safeguard the health of the mother. More in detail, drugs for induction of childbirth are indicated in the following cases:
- Pregnancy over the term;
- Membrane rupture after the thirty-fourth week in the absence of spontaneous labor;
- Presence of particular fetal and / or maternal conditions that require immediate intervention and induction of childbirth (for example, pre-eclampsia, diabetes mellitus, etc.);
- Endouter fetal death.
Types
Types of Medications for Induction of Childbirth
The drugs for induction of birth currently used in the therapeutic field are essentially of two types: oxytocin and prostaglandins . Both these types of drugs are able to stimulate uterine contractions and induce relaxation of the cervix, thus favoring the appearance of labor and the birth of the baby. Depending on the medicinal product that the doctor decides to use, the drugs can be administered locally either vaginally or parenterally by intravenous infusion.
On the market there are drugs for the induction of childbirth based on prostaglandins of different types: some of them are used to promote labor and the birth of the live fetus; others, instead, are indicated only and exclusively to induce childbirth in the case of fetal endouterine death. However, the main characteristics of both oxytocin and prostaglandins used in this field will be briefly described below.
Oxytocin
Oxytocin for Inducing Childbirth
Oxytocin is a hormone naturally produced by the body that has many functions within it. At the end of pregnancy, this hormone is responsible for stimulating uterine contractions and inducing labor.
The oxytocin obtained synthetically is part of the composition of drugs for the induction of childbirth administered to the expectant mother by intravenous medical personnel only and exclusively in the hospital setting.
Action mechanism
The drugs for the induction of childbirth based on oxytocin (Syntocinon®) act in a similar way to the hormone naturally produced by the body. More in detail, the oxytocin contained in them binds to the specific receptors for oxytocin (receptors linked to G proteins) present at the uterine level. Once the bond is made, the receptors are activated causing a cascade of signals that leads to the contraction of the smooth muscle of the uterus with consequent induction of labor and delivery.
Side effects
The oxytocin-based drugs for inducing childbirth can cause side effects exactly as can occur with the administration of any other drug, even if the active ingredient in question has natural origins. However, among the main adverse effects that can occur, we recall:
- Hypotension;
- Cardiac arrhythmias;
- Nausea and vomit;
- Uterine hypertonicity;
- Uterine rupture;
- Disseminated intravascular coagulation;
- Allergic reactions in sensitive individuals;
- Fetal distress;
- Fetal asphyxia;
Of course, although oxytocin has natural origins, following the use of medicines that contain it, the possibility of the onset of allergic reactions in sensitive patients cannot be excluded.
Did you know that ...
The medicinal products based on oxytocin can also be used to treat any post-partum bleeding . However, for more information about the therapeutic indications, the mechanism of action, the dosage and the side effects of oxytocin, read also the specific article: Oxytocin as a drug.
Dinoprostone
Dinoprostone for Inducing Childbirth
In the group of prostaglandins included in the composition of drugs for the induction of childbirth we find dinoprostone, or natural prostaglandin E2 . It is, in fact, a prostaglandin that is found in different types of medicines formulated for local administration at vaginal level (vaginal gel, vaginal devices), or formulated for intravenous administration (solution for injection).
Action mechanism
Dinoprostone (Propess®, Prostin E2®) is nothing but E2 natural prostaglandin. It plays a fundamental role at the end of the pregnancy as it is responsible for the maturation of the cervix, that is to say the modifications that cause a marked relaxation of the cervical smooth muscle of the cervix, dilating it and thus favoring the passage of the child through the birth canal.
Side effects
Similarly to what was said for the drugs for the induction of birth based on oxytocin, even those based on dinoprostone can cause side effects. Among these, we recall:
- Uterine hypertonicity;
- Uterine rupture;
- Transient vagal symptoms;
- Hypotension or hypertension;
- Nausea and vomit;
- Administration site reactions;
- Heart rate disorders in the fetus;
- Fetal death in the most severe cases.
Also in this case, despite the fact that dinoprostone is the natural prostaglandin E2, it is possible that allergic reactions will occur in sensitive patients following the administration of drugs to induce the delivery of the birth.
Did you know that ...
Dinoprostone can be used both for the induction of labor in the presence of a live fetus, and for the induction of childbirth in case of intrauterine fetal death.
Fetal death
Use of drugs for the induction of childbirth in the case of Intrauterine Fetal Death
As mentioned in the dedicated chapter ("Indications"), the use of drugs for induction of childbirth is also indicated in case of intrauterine fetal death. In such situations, synthetic prostaglandins are used, such as:
- Sulprostone (synthetic analogue of prostaglandin E2);
- Gemeprost (synthetic analogue of prostaglandin E1).
sulprostone
Sulprostone (Nalador®) is a synthetic analogue of prostaglandin E2 . It is administered through an intravenous infusion and acts by stimulating the uterine smooth muscle, favoring the contraction of the uterine body and the constriction of the uterine vessels . In this way, there is a rapid, albeit delicate, detachment of the placenta from the uterine body and the expulsion of the fetus. In addition to this, sulprostone is also able to induce a delicate and slow dilation of the cervical canal, facilitating and sometimes avoiding mechanical dilation.
Among the possible side effects induced by the administration of sulprostone are: hypotension or hypertension, bradycardia, pulmonary edema, bronchospasm, gastric spasm, rupture of the uterus and allergic reactions in sensitive patients.
Did you know that ...
Sulprostone is indicated not only for inducing childbirth in case of intrauterine fetal death, but also in cases where it is necessary to induce abortion for maternal or fetal indications and in cases where it is necessary to treat postpartum hemorrhages.
gemeprost
Gemeprost (Cervidil®) is another active ingredient used to induce childbirth in cases of intrauterine fetal death. Unlike sulprostone, it is a synthetic analogue of prostaglandin E1 . Gemeprost is available in drugs for induction of birth to be applied locally and, more precisely, in the form of vaginal ovules . Once administered, it is capable of stimulating uterine contractions and favoring dilation of the cervix, thus allowing the expulsion of the fetus.
Among the side effects that may occur following the administration of gemeprost, include: hypotension or hypertension, palpitations, nausea and vomiting, diarrhea, dizziness, headache, coronary spasms, allergic reactions in sensitive patients.
Did you know that ...
In addition to being part of drugs for induction of childbirth, gemeprost can be used to soften the cervix even in the case of abortion and when it is necessary to perform instrumental diagnostic interventions (for example, endometrial biopsy), surgery (curettage) or when it is necessary to insert intrauterine devices (IUD).
Contraindications
Contraindications to the use of Medications for Induction of Childbirth
Although drugs for inducing childbirth have contraindications that may vary depending on the active ingredient they contain, there are common conditions in which their use is contraindicated. Generally speaking, it is possible to state that the use of drugs to induce childbirth is not indicated in the following cases:
- Allergy known to the active ingredient or to any of the excipients contained in the drug for the induction of birth that must be used;
- Relevant cephalo-pelvic disproportion (in other words, it is a condition in which the baby's head is too large to pass through the mother's pelvis);
- Presence of placenta previa;
- Viral infections in the mother (for example, HIV, HCV, active herpes, etc.);
- Presence in the mother of previous traumas to the pelvis;
- Earlier surgical procedures of the uterus of different types (including any previous parts with cesarean section);
- Presence of anatomical anomalies in the fetus for which natural childbirth could represent a contraindication;
- Presence of fetal cardiovascular abnormalities.
Furthermore, it should be pointed out that the drugs for the induction of childbirth used in fetal endouterine death - with the exception of dinoprostone - must NOT be used to induce labor when the fetus is alive. However, it should be remembered again that all drugs for induction of childbirth can only be used in a hospital setting and must be administered strictly by specialized health personnel.
Please note
For more information about the contraindications to the use of drugs for inducing childbirth, it is necessary to consult a doctor and refer to the package leaflets for the medicinal products to be used.
