Pregnancy misoprostol

Misoprostol is used cautiously in women of childbearing age. Mesalamine, olsalazine, sucralfate, and sulfasalazine are Pregnancy Category B drugs all are used with caution during pregnancy (safety has not been established) and lactation. 

Uterine rupture has been reported when misoprostol was administered intravaginally in pregnant women to induce labor or to induce abortion beyond the first trimester of pregnancy. 

Uterine perforation has been reported following administration of combined vaginal and oral misoprostol in pregnant women to induce abortion. In each of these reported cases, the gestational age of the pregnancies was unknown. 

Pregnancy term/naf/on- Misoprostol has been used in combination with mifepristone for pregnancy termination. Patients taking mifepristone must take 400 meg misoprostol orally 2 days after taking mifepristone unless a complete abortion has already been confirmed before that time. 

Uterus and pregnancy The whole pregnancy period Avoid NSAIDs in the last trimester. Use NSAIDs in first and second trimester only after careful consideration of possible risks (early miscarriages and malformations, respectively). Misoprostol is contraindicated throughout pregnancy... 

Gonzalez CH, Vargas FR, Perez AB, Kim CA, Brunoni D, Marques-Dias MJ, Leone CR, Correa Neto J, Llerena Junior JC, de Almeida JC. Limb deficiency with or without Mobius sequence in seven Brazilian children associated with misoprostol use in the first trimester of pregnancy. Am J Med Genet 1993 47(l) 59-64. 

A systematic review of the use of misoprostol for induction of labor has been published (16). The meta-analysis included all randomized clinical trials registered in the Cochrane Pregnancy and Childbirth Group. Vaginal misoprostol was associated with increased uterine hyperstimulation, both without fetal heart changes (RR = 1.67 Cl = 1.30, 2.14) and with associated fetal heart rate changes (RR = 1.45 Cl = 1.04, 2.04). There was also an increase in meconium-stained amniotic fluid (RR = 1.38 Cl = 1.06,1.79). 

There were four deaths in previously healthy women due to endometritis and toxic shock syndrome within 1 week after medically induced abortions with oral mifepristone 200 mg and vaginal misoprostol 800 micrograms in two cases Clostridium sordellii was found (19). Another similar case was reported in Canada in 2001. Endometritis and toxic shock syndrome associated with C. sordellii are rare. Of 10 cases identified by authors in the previous literature, eight occurred after the delivery of live-born infants, one after a medical abortion, and one was not associated with pregnancy. The cases produced an FDA alert with a Dear Health Care Provider letter from the manufacturer and publication of a Dispatch in the Morbidity and Mortality Weekly Report (20). 

Seven pregnant women who had uterine rupture after intravaginal administration of misoprostol for induction of labor (SEDA-23, 436) had all undergone cesarean section in previous pregnancies (28). 

Data from Brazil, where misoprostol has been used orally and vaginally as an abortifacient, have suggested a relation between the use of misoprostol by women in an unsuccessful attempt to terminate pregnancy and Mobius syndrome (congenital facial paralysis) in their infants (33). The frequencies of misoprostol use during the first trimester by mothers of infants in whom Mobius syndrome was diagnosed and mothers of infants with... 

Mothers who used misoprostol during pregnancy as an abortifacient had an increased risk of having a baby with congenital anomalies (OR = 2.4 95% Cl = 1.0, 6.2), as reported in a case-control study in Fortaleza, Brazil (36). Multiple malformations have been described associated with the use of misoprostol (37). 

Tang OS, Miao BY, Lee SW, Ho PC. Pilot study on the use of repeated doses of sublingual misoprostol in termination of pregnancy up to 12 weeks gestation efficacy and acceptability. Hum Reprod 2002 17(3) 654-8. 

Ghorab MN, El Helw BA. Second-trimester termination of pregnancy by extra-amniotic prostaglandin F2alpha or endocervical misoprostol. A comparative study. Acta Obstet Gynecol Scand 1998 77(4) 429-32. 

Kim JO, Han JY, Choi JS, Ahn HK, Yang JH, Kang IS, Song MJ, Nava-Ocampo A A. Oral misoprostol and uterine rupture in the first trimester of pregnancy a case report. Reprod Toxicol 2005 20(4) 575-7. 

Gonzalez CH, Marques-Dias MJ, Kim CA, Sugayama SM, Da Paz JA, Huson SM, Holmes LB. Congenital abnormalities in Brazilian children associated with misoprostol misuse in first trimester of pregnancy. Lancet 1998 351(9116) 1624-7. 

Vimala N, Mittal S, Kumar S, Dadhwal V, Sharma Y. A randomized comparison of sublingual and vaginal misoprostol for cervical priming before suction termination of first-trimester pregnancy. Contraception 2004 70 117-20. 

Various anti-progestogenic routines for the termination of pregnancy continue to be compared. Of 354 women who were given mifepristone 200 mg in the clinic and then sent home with two tablets of misoprostol 200 micrograms to take 48 hours later, 324 (91.5%) had a successful termination (7). The most common adverse effects were pain or cramps (93%) and nausea (67%), followed by weakness (55%), headache (46%), and dizziness (44%). Overall acceptability of the regimen was high 63% of women reported that it was very satisfactory and another 23% found it satisfactory . There were no serious complications and the simplified routine, with a much reduced duration of hospital care, was considered acceptable. 

Bagga R, Chaudhary N, Kalra J. Rupture in an unscarred uterus during second trimester pregnancy termination with mifepristone and misoprostol. Int J Gynecol Obstet 2004 87 42-3. 

Creinin MD, Schwartz JL, Pymar HC, Fink W. Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy report of a randomised trial. BJOG 2001 108(5) 469-73. 

Jain, J.K., and D.R. Mishell. 1994. A comparison of intravaginal misoprostol with prostaglandin E2 for termination of second trimester pregnancy. N Engl J Med 331 290. 

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