Misoprostol (OB)
Cervical ripening before induction, Postpartum hemorrhage, Early pregnancy failure management
Indications
- Cervical ripening before induction
- Postpartum hemorrhage
- Early pregnancy failure management
Adult dosing
- cervical ripening: dose: 25; unit: mcg; route: PV q4h; interval: May repeat q4h; hold if adequate contractions; fixed: true; pph: dose: 800; unit: mcg; route: PR (rectal); interval: Single dose for PPH when other uterotonics fail; fixed: true; early pregnancy loss: dose: 800; unit: mcg; route: PV; interval: May repeat once in 24-48h if incomplete; fixed: true
Contraindications
- Prior cesarean delivery or uterine surgery (cervical ripening use — uterine rupture risk)
- Allergy to prostaglandins
Clinical pearls
- CONTRAINDICATED for cervical ripening in patients with prior cesarean delivery — uterine rupture risk
- For PPH: 800-1000 mcg PR is the dose (NOT the 25mcg ripening dose)
- Can cause tachysystole — monitor fetal heart rate closely during cervical ripening
- Stable at room temperature — ideal for resource-limited settings
Source and review
- ACOG Practice Bulletin No. 107; WHO Model List of Essential Medicines. Last reviewed: 2024-11-01