title: 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.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, National University of Singapore, Singapore, Singapore.
authors.forename: Yap-Seng
authors.initials: YS
authors.lastname: Chong
authors.forename: Selina
authors.initials: S
authors.lastname: Chua
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.forename: Sabaratnam
authors.initials: S
authors.lastname: Arulkumaran
mesh_terms: 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*
chemical_list: D010120:Oxytocics; D012996:Solutions; D013607:Tablets; D016595:Misoprostol; C038346:syntometrine; D010121:Oxytocin; D004874:Ergonovine