Potential Use of Misoprostol in Obstetrics and Gynaecology
Varsha Kotwal*
Senior Consultant Obstetrics and Gynaecology, New District Hospital Doda, India
Submission: April 29, 2019; Published: May 15, 2019
*Corresponding author: Varsha Kotwal, Senior Consultant, Obstetrics and Gynaecology, New District Hospital Doda, India
How to cite this article: Varsha Kotwal. Potential Use of Misoprostol in Obstetrics and Gynaecology. J Gynecol Women’s Health. 2019: 15(2): 555908. DOI: 10.19080/JGWH.2019.15.555908
Abstract
Misoprostol is a synthetic prostaglandin E1 analogue that is used off label for a variety of purposes in the practice of Obstretics and gynaecology which includes medical termination of pregnancy, medical management of abortion, artificial induction of labour, ripenng of cervix before surgical procedures, and the treatment of postpartum haemorrhage. So, due to its wide ranging applications in reproductive health, misoprostol is on the model lst of essential medicines of world health organization. The man focus of this article is to briefly review the potential use of misoprostol in Obstetics and Gynaecology.
Keywords: Misoprostol; Prostaglandin; Heamorrhage; Gynaecology
Introduction
Misoprostol is sold under the brand name Cytotec. It a medication which is used to prevent and treat stomach ulcers, nduce labour, cause an abortion and treat postpartum haemorrhage due to poor contraction of uterus [1,2]. Its effectiveness for abortion is between 66% and 90% and s often used with mifepristone or methotrexate [3-5]. It’s administered orally to treat gastric ulcers but for labour induction or abortion, it is taken either in the cheek, under the tongue or places in vagina [3,6]. The effects of misoprostol are dose dependent and it includes cervical softening and dilation, contraction of uterus, nausea, vomiting, diarrhea, fever and chills [1]. However it has various other advantages over other synthetic prostaglandins analogues like: its low cost, long shelf life, lack of need of refrigerator and its worldwide availability.
Routes of Administration of Misoprostol
Various routes of administration are oral, vaginal, sublingual, buccal or rectal. Comparison of oral and vaginal administration have shown that vaginal administration is associated with slower absorption. It is also associated with overall greater exposure to drug and greater effects on cervix and uterus. Sublingual pattern show greater absorption and high peaks levels. Buccal pattern show lower area under the curve and has lower side effects. Nonetheless buccal and vaginal routes have similar effects on uterine tone and activity [7-9].
Medical Abortion
600mg of oral mifepristone with 400μg of oral misoprostol 48hrs later for pregnancies up to 49 days of gestation is approved by FDA in 2000. Success rate of these regimes ranges from 95% to 98% with failure due to ongoing pregnancy is 1% approximately. Medical termination of pregnancy icessarily involves heavy bleeding and cramping as the pregnancy s expelled. Other side effects include nausea, vomiting, fever and chills. The death rate for mifepristone aborton is 1 per 100000 women, that too due to fatal sepsis28. When mifepristone is not available, misoprostol is used alone.
Cervical Ripening before Surgical Abortion
Misoprostols a proven cervical ripening agent prior to first trimester surgical abortion36. studies have shown that its possible dose s 400μg37 . routes of administration can be oral, vaginal, sublingual.
Use of Misoprostol in Hysteroscopy
The main aim of using misoprostol in hysteroscopy s to prevent complications of mechanical dilations such as cervical laceration, uterne perforation and creation of false passage 50. Studies have shown that misoprostol leads to a much greater dilation, decreased need of more dilation and reduced the rate of cervical laceration n premenopausal women51. The greatest benefits were seen n nulliparous women and with operative hysteroscopy.
Induction of Labour With a Viable Fetus
In comparison with placebo, misoprostol causes cervical rpening before induction with oxytocin 8182. It is administrated vaginally and the used dose is 25μg every 4 hours as needed, with a maximum dose of 150μg 85. Primary outcomes ncluded rate of vaginal delvery within 24 hours, incidences of uterine hyperstimulation with fetal heart rate changes, rate of cesarean delivery, and risk of serious adverse event in mother or fetus.
Post-Partum Haemorrahage
Apart from its uterine properties, misoprostol s used to treat post partum haemorrahages. Studies have shown that 1000μg of rectal administration of misoprostol when given to patients controlled post-partum haemorrhage within 3 minutes 94.
Conclusion
In a nutshell, misoprostol has many implications in Obstretics and gynaecology. Research is going on its potential use to apply in different complications. Its low cost and easy use make it a potential drug to improve women’s health worldwide.
References
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