Acute convulsions following sublingual misoprostol administration for postpartum hemorrhage: a report of two cases

Shri R. Rundla; Ankita Dadhwal; Tanvi Katoch; Sonika Sharma

doi:10.18203/2320-1770.ijrcog20260916

Authors

Shri R. Rundla Department of Obstetrics and Gynecology, AIIMS, Bilaspur, Himachal Pradesh, India https://orcid.org/0009-0003-9896-9206
Ankita Dadhwal Department of Obstetrics and Gynecology, AIIMS, Bilaspur, Himachal Pradesh, India
Tanvi Katoch Department of Obstetrics and Gynecology, AIIMS, Bilaspur, Himachal Pradesh, India
Sonika Sharma Department of Obstetrics and Gynecology, AIIMS, Bilaspur, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260916

Keywords:

Misoprostol, Postpartum hemorrhage, Seizures, Sublingual route, Neurotoxicity

Abstract

Misoprostol is widely used for the prevention and treatment of postpartum hemorrhage (PPH) because of its efficacy, affordability, and ease of administration. However, the sublingual route is associated with rapid absorption and higher peak plasma concentrations, which may increase the risk of systemic adverse effects. We report two cases of primigravida women who developed acute altered mental status, hallucinations, and generalized tonic–clonic seizures following administration of 800 µg sublingual misoprostol after vaginal delivery. Extensive evaluation excluded common obstetric and neurological causes of postpartum seizures. Both patients recovered completely with supportive management and anticonvulsant therapy. These cases highlight the possibility of severe neurotoxicity associated with high-dose sublingual misoprostol and emphasize the need for cautious use and careful monitoring in the postpartum period.

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