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Prostaglandin E1 Analogue Pregnancy: X — teratogenic (Möbius syndrome risk in first trimester misuse)

Misoprostol

Brand names: Cytotec

Adult dose

Dose: PPH prevention: 600 mcg SL or PR at delivery. Cervical ripening: 25 mcg vaginally every 3–6h. Medical TOP: 800 mcg vaginally or SL after mifepristone 200mg 24–48h prior
Route: Sublingual, vaginal, or oral
Frequency: Per indication
PPH treatment: 800–1000 mcg PR/SL (WHO protocol). Miscarriage management: 800 mcg vaginally, repeat if needed.

Clinical pearls

  • Thermostable — unlike oxytocin, does not require refrigeration (crucial in resource-limited settings)
  • SL route: fastest onset but highest fever/shivering rate
  • WHO: misoprostol 600mcg SL is recommended for PPH prevention when oxytocin unavailable
  • Medical abortion: combined mifepristone + misoprostol is >95% effective at <10 weeks

Contraindications

  • Previous uterine scar with cervical ripening regimens
  • Active PID
  • Unexplained vaginal bleeding (cervical ripening)

Side effects

  • GI upset
  • Diarrhoea
  • Fever and chills (especially SL — common)
  • Uterine hyperstimulation
  • Headache

Interactions

  • Oxytocin — additive uterotonic (space by 6h if both used)
  • Antacids (Mg-containing) — increased misoprostol levels

Monitoring

  • Uterine contractions (cervical ripening)
  • Fetal heart rate
  • Temperature and vital signs
  • Blood loss (PPH)

Reference: WHO PPH Prevention Guidelines; RCOG Medical Management of Miscarriage. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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