title: Vaginal misoprostol administration for cervical ripening and labor induction.
abstract: Intravaginal misoprostol has been shown to be an effective agent for cervical ripening and induction of labor. Vaginal application of misoprostol has been reported in over 9000 women worldwide and seems to have safety profile similar to that of endocervically and intravaginally administered dinoprostone. Concern arises with the use of higher doses of intravaginal misoprostol (50 mcg or more) and the association with uterine contractile abnormalities and for this reason, use of low-dose misoprostol regimen has been recommended by the American College of Obstetricians and Gynecologists. The recommendation is use of a 25-mcg dose of misoprostol inserted into the posterior vaginal fornix and repeated every 3 to 6 hours as needed. Misoprostol administration to women with prior cesarean births seems to increase the likelihood of uterine scar disruption and should not be used in these women. There are reports of uterine rupture in women with unscarred uteri treated with vaginally applied misoprostol. Therefore, all patients need to be monitored adequately after misoprostol administration. Although there is a growing body of data regarding the ambulatory use of intravaginal misoprostol for cervical ripening, its use for this purpose cannot be recommended outside of investigational protocols at this time because of concerns for maternal and neonatal safety.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics-Gynecology, University of California, Irvine, School of Medicine, Irvine, California, USA. dwing@uci.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Wing
authors.forename: Cecilia A Lyons
authors.initials: CA
authors.lastname: Gaffaney
mesh_terms: D000282:Administration, Intravaginal; D000553:Ambulatory Care; D020070:Cervical Ripening / Q000187:drug effects*; D002585:Cesarean Section; D004305:Dose-Response Relationship, Drug; D004348:Drug Labeling; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D011247:Pregnancy
chemical_list: D010120:Oxytocics; D016595:Misoprostol