Misoprostol: history and clinical aspects
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253570Keywords:
Misoprostol, Prostaglandins, Abortion, Medical termination of pregnancy, Postpartum haemorrhageAbstract
Misoprostol, a synthetic prostaglandin E1 analog, was originally developed for NSAID-induced gastric ulcers and is now widely used in obstetric and gynaecologic procedures. It acts as a prodrug, rapidly converted in the liver to misoprostol acid, which binds EP-3 receptors to induce uterine contractions. Misoprostol is effective for medical abortion, postpartum hemorrhage prevention, labour induction, cervical preparation and reducing blood loss during gynaecologic surgeries. Administration routes include oral, sublingual, buccal, rectal and vaginal, with dosing tailored to indication and gestational age. Adverse effects are generally mild but may include diarrhoea, nausea, fever and rarely, uterine rupture or teratogenic effects. Contraindications include prostaglandin hypersensitivity and advanced pregnancy with prior uterine scars. Overall, misoprostol is a versatile, generally safe drug with significant clinical applications in reproductive health.
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References
Choksuchat C. Clinical use of misoprostol in nonpregnant women. J Min Inv Gynecol. 2010;17(4):449-55. DOI: https://doi.org/10.1016/j.jmig.2010.03.015
Baskett, TF. The Development of Prostaglandins. Best Pract Res Clin Obstet Gynaecol. 2003;17(5):703–6. DOI: https://doi.org/10.1016/S1521-6934(03)00048-8
Collins PW. Misoprostol: discovery, development and clinical applications. Med Res Rev. 1990;10(2):149–72. DOI: https://doi.org/10.1002/med.2610100202
Wang S, Wu F, Han Y. Pharmacokinetics and Bioequivalence of Misoprostol Tablets: An Open-Label, Randomized, Single-Dose, Crossover Study With Healthy Chinese Volunteers. Clin Pharmacol. Drug Dev. 2022;11(8):949–56. DOI: https://doi.org/10.1002/cpdd.1102
Krugh M, Patel P, Maani CV. Misoprostol. In StatPearls. StatPearls Publishing. 2024.
Aronoff DM, Neilson EG. Antipyretics: mechanisms of action and clinical use in fever suppression. Am J Med. 2001;111(4):304–15. DOI: https://doi.org/10.1016/S0002-9343(01)00834-8
Shaheen M, Sharma R. Misoprostol-A Wonder Drug. Bangladesh J Med Sci. 1970;10(4):221–5. DOI: https://doi.org/10.3329/bjms.v10i4.9490
Rostom A, Dube C, Wells G. Prevention of NSAID-Induced Gastroduodenal Ulcers. Cochrane Database Syst. Rev. 2002;4:2296. DOI: https://doi.org/10.1002/14651858.CD002296
World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage; World Health Organization: Geneva. 2012.
Goldberg AB, Greenberg MB, Darney PD. Misoprostol and Pregnancy. N Engl J Med. 2001;344(1):38–47. DOI: https://doi.org/10.1056/NEJM200101043440107
Brandell K, Jar-Allah T, Reynolds-Wright J. Randomized trial of very early medication abortion. New England J Med. 2024;391(18):1685-95. DOI: https://doi.org/10.1056/NEJMoa2401646
Ashok PW, Flett GM, Templeton A. Termination of Pregnancy at 9-13 Weeks’ Amenorrhoea with Mifepristone and Misoprostol. Lancet Lond Engl. 1998;352(9127):542–3. DOI: https://doi.org/10.1016/S0140-6736(05)79250-3
Wasim T, Waheed K, Nasreen T, Wasim A, Zunair J, Saqib AB. Oral vs Vaginal Misoprostol for Inducing Labor at Term: Randomized Controlled Trial. MedERA-J CMH LMC and IOD. 2024;6(2):457. DOI: https://doi.org/10.61982/medera.v6i2.240
ACOG Practice Bulletin No. 107: Induction of Labor. Obstet Gynecol. 2009;114(1):386–97. DOI: https://doi.org/10.1097/AOG.0b013e3181b48ef5
Hua Y, Zhang W, Hu X, Yang A, Zhu X. The use of misoprostol for cervical priming prior to hysteroscopy: a systematic review and analysis. Drug Design, Dev Ther. 2016;5:2789-801. DOI: https://doi.org/10.2147/DDDT.S111625
Wali S, Balfoussia D, Touqmatchi D. Misoprostol for Open Myomectomy: A Systematic Review and Meta-Analysis of Randomised Control Trials. BJOG Int J Obstet Gynaecol. 2021;128(3):476–83. DOI: https://doi.org/10.1111/1471-0528.16389
da Silva Dal Pizzol T, Knop FP, Mengue SS. Prenatal Exposure to Misoprostol and Congenital Anomalies: Systematic Review and Meta-Analysis. Reprod Toxicol. 2006;22(4):666–71. DOI: https://doi.org/10.1016/j.reprotox.2006.03.015
Tang OS, Gemzell‐Danielsson K, Ho PC. Misoprostol: Pharmacokinetic Profiles, Effects on the Uterus and Side‐effects. Int J Gynecol Obstet. 2007;99(2):875. DOI: https://doi.org/10.1016/j.ijgo.2007.09.004
Orioli IM, Castilla EE. Epidemiological Assessment of Misoprostol Teratogenicity. BJOG Int J Obstet Gynaecol. 2000;107(4):519–23. DOI: https://doi.org/10.1111/j.1471-0528.2000.tb13272.x
Derman RJ, Kodkany BS, Goudar SS. Oral Misoprostol in Preventing Postpartum Haemorrhage in Resource-Poor Communities: A Randomised Controlled Trial. Lancet Lond Engl. 2006;368(9543):1248–53. DOI: https://doi.org/10.1016/S0140-6736(06)69522-6
Chong YS, Chua S, El-Refaey H, Choo WL, Chanrachakul B, Tai BC, Rodeck C, Arulkumaran S. Postpartum intrauterine pressure studies of the uterotonic effect of oral misoprostol and intramuscular syntometrine. British J Obst Gynaecol. 2001;108(1):41-7. DOI: https://doi.org/10.1016/S0306-5456(00)00014-0
Henkel A, Miller H, Owens S. P048Risk of Uterine Rupture in Second-Trimester Medication Abortions Using Mifepristone and Misoprostol after Cesarean Section Birth: A Systematic Review and Meta-Analysis. Contraception. 2022;116:84–5. DOI: https://doi.org/10.1016/j.contraception.2022.09.072
Abdel-Aleem H, Villar J, Gülmezoglu AM. The Pharmacokinetics of the Prostaglandin E1 Analogue Misoprostol in Plasma and Colostrum after Postpartum Oral Administration. Eur J Obstet Gynecol Reprod Biol. 2003;108(1):25–8. DOI: https://doi.org/10.1016/S0301-2115(02)00355-X
Barros JG, Reis I, Graça LM. Acute Misoprostol Toxicity during the First Trimester of Pregnancy. Int J Gynecol Obstet. 2011;113(2):157–8. DOI: https://doi.org/10.1016/j.ijgo.2010.12.006