Amnioreduction refers to the removal of excess amniotic fluid. Under ultrasound guidance and after numbing of the mother's abdominal wall, a long, very fine needle is introduced into the uterus and into the amniotic cavity. While the fetus is being monitored with ultrasound, excess fluid from the amniotic cavity is withdrawn. It is similar to amniocentesis, where a small amount of amniotic fluid is removed for diagnostic reasons. Amnioreduction is performed for the purpose of reducing large amounts of fluid, in order to correct too much amniotic fluid.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drug Breakthrough Option: Sulindac

Cervical Ripening

In pregnancy, the uterine cervix serves two major functions. First, it maintains its firmness during pregnancy as the uterus dramatically enlarges. This physical integrity is critical so that the developing fetus can remain in the uterus until the appropriate time for delivery. Second, in preparation for labor and delivery, the cervix softens and becomes more distensible, a process called cervical ripening. These chemical and physical changes are required for cervical dilatation, labor, and delivery of a fetus. In women with a medical or obstetrical need for induction of labor, certain agents can "ripen" the cervix to facilitate the induction process.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drug Breakthrough Option: Misoprostol

Ectopic Pregnancy

An ectopic pregnancy is a condition where a fertilized egg settles and grows in a location other than the inner lining of the uterus. The vast majority of ectopic pregnancies occurs in the fallopian tube (95%), but they can occur elsewhere, such as the ovary, cervix, and abdominal cavity. In the United States an ectopic pregnancy occurs in about one in 60 pregnancies. The major health risk of this condition is internal bleeding.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drug Breakthrough Option: Methotrexate

External Cephalic Version

External cephalic version is the changing of a baby’s position in the uterus by manipulation of the mother’s abdomen. Usually it is done to turn a breech baby to a vertex (headfirst) position. A breech baby’s bottom or feet are in a position to come out before the head during delivery through the birth canal. Such a delivery may be hazardous because for example, the baby’s head may become trapped in the mother’s cervix. If the baby is moved to a headfirst position, you may avoid having a vaginal breech delivery or cesarean section.

Commonly Prescribed (On-Label) Drugs: Nitroglycerin

Off-Label Prescription Drug Breakthrough Option: Terbutaline

Fetal Distress

Fetal distress refers to a difficulty the fetus encounters before labor or during the birth process. The term “fetal distress” is commonly used to describe low oxygen levels in the fetus (hypoxia). Fetal hypoxia may result in fetal damage or death if not reversed promptly. Fetal distress can be detected when the following signs are observed: abnormal slowing of labor, the presence of meconium (dark green fecal material from the fetus), other abnormal substances in the amniotic fluid, or abnormal indications on fetal electronic monitoring.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drugs Breakthrough Options: Dexamethasone, Terbutaline

Hyperemesis Gravidarum

Nausea and vomiting during pregnancy, more widely known as morning sickness, is a common condition. Hyperemesis gravidarum is a rare disorder characterized by severe and persistent nausea and vomiting during pregnancy that may cause dehydration, vitamin and mineral deficit, and the loss of greater than five percent of their original body weight, and may necessitate hospitalization. Do not use any drug while pregnant without first consulting a physician.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drugs Breakthrough Options: Chlorpromazine, Droperidol, Metoclopramide, Prochlorperazine, Promethazine, Trimethobenzamide


Infertility is usually defined as not being able to get pregnant despite trying for one year. A broader view of infertility includes not being able to carry a pregnancy to term and have a baby. Infertility affects about 6.1 million Americans, or 10% of the reproductive age population, according to the American Society for Reproductive Medicine. It may be due to a single cause in either partner in a couple, or a combination of factors that prevents a pregnancy from occurring or continuing. The therapies in this section are for women.

Commonly Prescribed (On-Label) Drugs: Balsalazide, Bromocriptine, Clomiphene

Off-Label Prescription Drugs Breakthrough Options: Anastrozole, Letrozole, Tamoxifen

Labor Induction

Sometimes, if labor does not start on its own, doctors use medicines to help labor begin. This is called “labor induction.” The most common reason for labor induction is that the pregnancy has gone two weeks or more past the due date. The baby may get too big if you carry it this far past your due date and may not get enough nourishment from your body. Labor induction may also be recommended if there are concerns for you or your pregnancy for other reasons, such as, high blood pressure, infection, and diabetes.

Commonly Prescribed (On-Label) Drugs: Dinoprostone, Oxytocin

Off-Label Prescription Drugs Breakthrough Options: Carboprost, Mifepristone, Misoprostol

Ovulation Induction

Ovulation induction for in vitro fertilization, (IVF) uses medication to stimulate development of one or more mature follicles (where eggs develop) in the ovaries of infertile women who may not regularly develop mature follicles without the help. Ovulation induction may be necessary in women who do not ovulate consistently, but want to have a child. There are many reasons why women do not ovulate regularly.

Commonly Prescribed (On-Label) Drugs: Chorionic Gonadotropin, Follitropin Alfa, Follitropin Beta, Menotropins

Off-Label Prescription Drugs Breakthrough Options: Leuprolide, Nafarelin

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