Does the route of administration of misoprostol make a difference? The uterotonic effect and side effects of misoprostol given by different routes after vaginal delivery.
OBJECTIVE
To compare the postpartum uterotonic effect and side effects of misoprostol administered by different routes.


METHODS
Fifty women were given misoprostol 400 microg either by the oral solution, oral tablet, rectal or vaginal route, or intramuscular syntometrine 1 ml after spontaneous vaginal delivery. Pre- and post-treatment uterine activity were measured with intrauterine pressure catheters.


RESULTS
Uterine activity produced by oral solution misoprostol 400 microg was significantly higher than that of oral tablet, rectal and vaginal misoprostol (P = 0.004, 0.002, respectively). Onset of action after oral solution misoprostol was faster than by the oral tablet (P = 0.01), rectal (P < 0.001) and vaginal (P< 0.001) routes. Shivering and pyrexia were most common with oral solution misoprostol. Maximum body temperature recorded was significantly higher with oral solution misoprostol than with oral tablet, rectal and vaginal misoprostol (P = 0.009, 0.001, respectively).


CONCLUSIONS
Different routes of administering misoprostol greatly influence the effects achieved. Oral solution misoprostol produces the fastest and strongest uterotonic effect, with the most side effects.
Chong
Yap-Seng
YS
Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore.
Chua
Selina
S
Shen
Liang
L
Arulkumaran
Sabaratnam
S
D000282:Administration, Intravaginal; D000284:Administration, Oral; D000285:Administration, Rectal; D036861:Delivery, Obstetric; D004874:Ergonovine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007700:Kinetics; D016015:Logistic Models; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects*; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects; D010121:Oxytocin / Q000008:administration & dosage; D049590:Postpartum Period; D011247:Pregnancy; D011312:Pressure; D012996:Solutions; D013607:Tablets; D014590:Uterine Contraction / Q000187:drug effects; D014599:Uterus / Q000187:drug effects*
D010120:Oxytocics; D012996:Solutions; D013607:Tablets; D016595:Misoprostol; C038346:syntometrine; D010121:Oxytocin; D004874:Ergonovine