title: Precipitate delivery and postpartum hemorrhage after term induction with 200 micrograms misoprostol.
abstract: Misoprostol has been widely applied in early pregnancy termination and term pregnancy induction. However, the upper dosage limit of misoprostol through vaginal route has not been firmly established. Most popular dosages of vaginal misoprostol recommended are 25, 50 or 100 micrograms. There are no reports on the dangers of high-dosage misoprostol 200 micrograms as used in term labor induction. We present a primiparaous woman who was administered 200 micrograms misoprostol vaginally for term labor induction. The following precipitate delivery resulted in multiple lacerations of the isthmus, cervix and vagina, postpartum hemorrhage and disseminated intravascular coagulopathy. Inevitably, a hysterectomy was performed. A postsurgical check of the uterus confirmed lacerations of the isthmus and internal cervix. This rare complication suggests the possible dangers of vaginal misoprostol doses as high as 200 micrograms for term induction of labor at term.
authors.affiliation: Department of Obstetrics and Gynecology, China Medical College Hospital, Taichung, Taiwan, ROC.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Hsieh
authors.forename: H D
authors.initials: HD
authors.lastname: Tsai
authors.forename: C C
authors.initials: CC
authors.lastname: Chang
authors.forename: L S
authors.initials: LS
authors.lastname: Yeh
authors.forename: T C
authors.initials: TC
authors.lastname: Yang
authors.forename: T Y
authors.initials: TY
authors.lastname: Hsu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000009:adverse effects*; D007744:Obstetric Labor Complications / Q000139:chemically induced*; D010120:Oxytocics / Q000009:adverse effects*; D006473:Postpartum Hemorrhage / Q000139:chemically induced*; D011247:Pregnancy
chemical_list: D010120:Oxytocics; D016595:Misoprostol