Misoprostol use in obstetrics

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Misoprostol is a synthetic analogue of prostaglandin E1. In addition to inhibiting gastric acid secretion and protecting gastric mucosa, the drug can also stimulate uterine contractions and promote cervical ripening. Therefore, misoprostol is widely used in obstetrics. So how is Misoprostol in obstetrics used?

1. Misoprostol what use in obstetrics?

WHO recognizes the important role of misoprostol in obstetrics and gynecology and this role is reflected in the following 4 main uses: labor induction, prevention and treatment of postpartum haemorrhage (BHSS), spontaneous abortion and abortion. .

2. How to use Misoprostol

2.1 How to use Misoprostol in obstetrics for induction of labor
WHO has 2 recommendations for the use of Misoprostol in labor induction:
In induction of labor for term pregnancies and no history of cesarean section In Termination of pregnancy in cases involving fetal malformations or fetal death in the last 3 months of pregnancy The dosage for both of these recommendations is misoprostol 25 mcg every 2 hours orally or 25 mcg every 6 hours with vaginal route.
2.2 Use of Misoprostol in obstetrics for the prevention and treatment of postpartum haemorrhage
For the prevention of postpartum haemorrhage, intravenous oxytocin is considered more effective than oral misoprostol. But when oxytocin is not available, medical staff will use misoprostol replacement therapy to contract the uterus to prevent postpartum bleeding. The dosage of misoprostol is 600mcg orally.
In addition, misoprostol is also used to treat postpartum hemorrhage due to failure of uterine contractions with oxytocin failed or unavailable.
During the use of the drug, if the symptoms do not improve and increase, you should immediately notify the doctor for advice and appropriate treatment.
2.3 Use of misoprostol in obstetrics for medical abortion
Medical abortion with a pregnancy less than 9 weeks old: After taking 200 mg of Mifepristone for 24-48 hours, continue using 800 mcg of Misoprostol vaginally, lozenge cheek or sublingual. Vaginal misoprostol is more effective with fewer side effects than other routes of administration, oral misoprostol should only be used in fetuses less than 7 weeks of age. Medical abortion with pregnancy from 9-12 weeks: 36-48 hours after taking 200 mg Mifepristone use 800 mcg vaginal, then every 3 hours 400 mcg sublingually (maximum 5 doses). Medical abortion of pregnancy after 12 weeks: 36-48 hours after oral administration of 200 mg of mifepristone 800 mcg of misoprostol vaginally, every 3 hours sublingually 400 mcg of misoprostol until miscarriage (maximum 5 doses). Cervical preparation before surgical abortion up to 84-98 days (12-14 weeks): To improve cervical dilation before surgical abortion procedure one can use dilator Osmosis or Misoprostol. With misoprostol, a single dose of 400 mcg can be given either sublingually 2 hours or vaginally 3 hours before the procedure.

3. Misoprostol is contraindicated on which subjects?

Misoprostol is contraindicated in people who are allergic, have a history of hypersensitivity to misoprostol or to prostaglandins. Misoprostol is contraindicated in pregnant women because the drug can be dangerous to the fetus, even causing miscarriage. There have been reports of misoprostol causing birth defects, stillbirths, miscarriages but with no success. Therefore, do not arbitrarily use the drug without a doctor's prescription during pregnancy. Misoprostol is contraindicated in nursing women because misoprostol can be excreted in breast milk and cause diarrhea in nursing infants. Misoprostol is relatively contraindicated in women of childbearing age, or intending to become pregnant because of the potential for miscarriage, unless the patient needs to be treated with nonsteroidal anti-inflammatory drugs - NSAIDs and there is a risk. gastric ulcer complications when using this group of drugs. And misoprostol is only recommended for women who can become pregnant when effective and safe contraception has been used. Like other prostaglandins used to end pregnancy, misoprostol is contraindicated for use in people at high risk of uterine rupture such as a scarred uterus from previous caesarean section, multiple pregnancies, etc. Cerebrovascular disease, cardiovascular disease also have relative contraindications to the use of misoprostol. Use caution when giving misoprostol to people with inflammatory bowel disease, severe diarrhea, irritable bowel syndrome - IBS, and other intestinal problems.

4. What are the side effects of Misoprostol?

Misoprostol can cause some unwanted symptoms for women such as:
Mild to severe diarrhea, abdominal pain, bloating, indigestion, nausea, constipation. Headache. Dysmenorrhea, abnormal vaginal bleeding, menstrual disorders. Dizziness Low blood pressure. Pancreatitis. Asthenia, fatigue, depression, peripheral neuropathy

5. How to handle Misoprostol overdose or miss 1 dose of misoprostol

Symptoms when you overdose on misoprostol clinically reported such as sedation, tremor, convulsions, abdominal pain diarrhea, dyspnea, fever, palpitations, hypotension, bradycardia. Call or go to a medical facility right away for appropriate treatment.
When you miss a dose of misoprostol take it as soon as you remember the missed dose, but if it's too close to the next dose, skip the missed dose and take the next dose as usual. Never take a double dose. dose to compensate.

6. How to store misoprostol

Misoprostol should be kept out of the reach of children. Experts recommend storing misoprostol in a cool, dry place. Do not expose the medicine to direct light. Store at room temperature below 30 degrees Celsius.

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