Cervical ripening agents and uterine stimulants

The discussion of drugs for uterine stimulation is divided into discussion of labor induction versus labor augmentation. Use of cervical ripening agents for the induction of the unfavorable cervix has led to less failed inductions (Fig. 1). Misoprostol and dino-prostone are the most widely used pharmacologic agents for cervical repining. Oxytocin remains the only agent supported by a plethora of data for stimulation of uterine activity after the patient enters active labor. As cited above, a wide variety of acceptable dosing regimens exists. A common finding in comparing various uterine stimulants is more aggressive dosing regimens may reduce time in labor, but may increase the incidence of uterine hyperstimulation. The stimulation of labor with a viable fetus regardless of the agent or regimen requires monitoring of mother and fetus and the ability to promptly perform a cesarean if uterine stimulation is not tolerated by the fetus.