misoprostol

see also:

• miscarriage

• synthetic analogue of prostaglandin E1
• induces contractions of the smooth muscle fibers in the myometrium and relaxation of the uterine cervix.
• the uterotonic properties of misoprostol should facilitate cervical opening and evacuation of intrauterine debris and is commonly used in Australia “off-label” to assist in the medical Mx of miscarriage
• it is also used with mifepristone / RU486 in early termination of pregnancy when it is given 36 to 48 hours after the oral intake of mifepristone

• insert intravaginally as either 400ug or 800ug dose
• repeat in 24 hours if POC not passed
• advise adequate analgesia such as paracetamol, codeine, and non-steroidal anti-inflammatory drugs (NSAIDs)
• can avoid surgical Mx of missed miscarriage under 13wks gestation in ~80% of cases but has a 10-20% failure rate

• HS to misoprostol
• suspected ectopic pregnancy
• gestation > 13wks
  • uterine hyperstimulation and rupture have been reported beyond the first trimester when much lower dosage of misoprosotol may be required
• suspected coagulopathy
• IUCD in situ (remove it 1st)
• viable pregnancies unless termination is being undertaken
  • use has been associated with birth defects
• lactation
  • may cause diarrhoea in infants

• patients with cardiovascular disease as potential rare serious cardiovascular accidents
• epilepsy - seizures may occur
• asthma - bronchospasm may occur in susceptible patients
• avoid subsequent conception until the next normal menses

• nausea, vomiting, diarrhoea, abdominal pain
• frequent uterine contractions which may be painful
• vaginal bleeding
• headache, dizziness, fever
• breast tenderness
• neurogenic tinnitus
• other very uncommon effects