The Use of Misoprsotol in Pregnancy
Abstract
Misoprsotol is a ProstaglandinE1 analogue that had been approved by the Food and Drug Administration (FDA) to be taken orally for the prevention and treatment of gastric ulcers associated with the use of non steroidal anti-inflammatory drugs. It has also become an important drug in obstetrical practice because of its uterotonic and cervical ripening actions. Misoprsotol is useful in the treatment of miscarriage, cervical ripening before surgical evacuation in cases of embryonic death, fetal death and particularly in induction of labour. The drug may also be used to treat and even prevent postpartum hemorrhage. However misoprostol is not approved for any of these indications in the United States of America (USA), the manufacturing country or elsewhere. Current products labeling include a warning that misoprostol is contraindicated during pregnancy because of its abortifacient properties. However the Food and Drug Administration (FDA) recognizes that, in certain circumstances the “off-label” uses of approved drugs are appropriate, rational and accepted medical practice(1). Prescribing a medication for an off-label indication is common in the treatment of pregnant women and is not considered experimental if based on scientific evidence (2).
The purpose of this article is to review the large body of evidence supporting the use of misoprostol in pregnancy. This includes reviewing pharmacokinetics and physiology, mechanism of action, off-label conflicts, efficacy, dosage variations, different routes of administration and safety of misoprostol in pregnancy and postpartum haemorrhage under pregnancy three trimesters course.
References
1- House Committee on Government Reform and Oversight. Off-label drug use and FDA review of supplemental drug applications: hearing before the Subcommittee on Human Resources and Intergovernmental Relations. 104th Congress, 2nd session, September 12, 1996:53-94.
2- Rayburn WF. A physician’s prerogative to prescribe drugs for off-label uses during pregnancy. Obstet Gynecol 1993; 81:1052-1055.
3- Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption Kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997; 90:88-92.
4- Foote EF, Lee DR, Karim A, Keane WF, Halstenson CE. Disposition of Misoprotol and its active metabolite in patients with normal and impaired renal function. J Clin Pharmacol 1995; 35:384-389.
5- Ulmann A, Silvestre L. RU486: the French experience. Hum Reprod 1994; 9:Suppl 1:126-130.
6- El-Refaey H, Templeton A. Induction of abortion in the second trimester by a combination of misoprostol and mifepristone: a randomized comparison between two misoprostol regimens. Hum Reprod 1995;10:475-478.
7- Danielsson KG, Marions L, Rodriguez A, Spur BW, Wong PY, Bygdeman M. Comparison between oral vaginal administration of misoprostol on uterine contractility. Obstet Gynecol. 1999; 93:275-280.
8- Creinin MD, Darney PD. Methotrexate and misoprostol for early abortion. Contraception 1993;48: 339-348.
9- Toppozada MK, Anwar MY, Hassan HA, el-Gazaerly WS. Oral or vaginal misoprostol for induction of labor. Int J Gynaecol Obstet. 1997; 56:135-139.
10- G.D. Searle, to the editor. N Engl J Med. 2001; 4: 334:361.
11- Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. N Engl J Med 2001;334:38-47.
12- Induction of labour with misoprostol. ACOG committee opinion no.228. Washington, D.C.
13- Induction of labour. ACOG practice bulletin no.10. Washington, D.C.: American College of Obstetrician and Gynecologists, November 1999.
14- Stitely ML, Browsing J, Fowler M, Gendron RT, Gherman RB. Outpatient cervical ripening with intravaginal misoprostol. Obstet Gynecol 2000;96: 684-688.
15- Off label use of Misoprostol. 2000 American College of Obstetrician and Gynecologists 2000; 44:9.
16- W E Mackenzie. Misoprostol-Letters in the Lancet. 2001;13:3.
17- Marsden Wagner. Misoprostoland the politics of fear. The Lancet 2001;13:3.
18- Carbonell JL, Varela L, Velazco A, Fernandez C. The use of misoprostol for termination of early pregnancy. Contraction 1997;55:165-168.
19- Ngai SW, Tang OS, Chan YM, Ho PC. Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation: efficacy and acceptability. Hum Reprod 2000;15:1159-1162.
20- Creinin MD, Moyer R, Guido R. Misoprotol for medical evacuation of early pregnancy failure. Obstet Gynecol. 1997;89: 768-772.
21- Zalanyi S. Vaginal misoprostol alone is effective in the treatment of missed abortion. Br J Obstet Gynaecol. 1998; 105:1026-1028.
22- Herabutya Y, O-Prasertsawat P. Misoprotol in the management of missed abortion. Int J Gynaecol Obstet. 1997; 65:263-266.
23- Henshaw RC, Cooper K, el-Refaey H, Smith NC, Templeton AA. Medical management of miscarriage: non-surgical uterine evacuation of incomplete and inevitable spontaneous abortion. BMJ 1993;306:894-5
24- De Jonge ET, Makin JD, Manefeldt E, De Wet GH, Pattinson RC. Randomized clinical trail of medical evacuation and surgical curettage for incomplete miscarriage. BMJ 1995; 311:662-662.
25- Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA 1984; 251:2108-2111.
26- Schulz KF, Grimes DA, Cates WJ Jr. Measures to prevent cervical injury during suction curettage abortion. Lancet 1983; 1: 1182-1185.
27- El-Refaey H, Calder L, Wheatley DN, Templeton A. Cervical priming with prostaglandinEl analogues, misoprostol and gemeprost. Lancet 1994; 343: 1207-9.
28- Maclsaac L, Grossman D, Balistreri E, Darney P. A randomized controlled trail of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynaecol. 1999; 93: 766-770.
29- Singh K, Fong YF, Prasad RN, Dong F. Randomized trail to determine optimal dose of vaginal misoprostol for per-abortion cervical priming. Obstet Gynaecol. 1998; 92:795-798.
30- Bugalho A, Bique C, Almeida L, Bergstrom S. Application of vaginal misoprostol before cervical dilatation to facilitate first-trimester pregnancy interruption. Obstet Gynaecol. 1994; 83: 729-731.
31- Singh K, Fong YF, Prasad RN, Dong F. Evaluation interval after vaginal misoprostol for pre-abortion cervical priming: a randomized trail. Obstet Gynaecol. 1999; 94:431-434.
32- Jain JK, Mishell DR Jr. A comparison of intravaginal misoprostol with prostaglandinE2 for termination of second-trimester abortion. N Engl J Med 1994; 331:290-293.
33- Jain JK, Mishell DR Jr. A comparison of misoprostol with and without laminaria tents for induction of second-trimester abortion. Am J Obstet Gynaecol. 1996; 175:173-177.
34- Jain JK, Kou J, Mishell DR Jr. A comparison of two dosing regimens of intravaginal misoprostol for second-trimester pregnancy termination. Obstet Gynaecol. 1999; 93:571-575.
35- Wong KS, Ngai CS, Wong AY, Tang LC, Ho PC. Vaginal misoprostol compared with vaginal gemeprost in termination of second trimester pregnancy: a randomized trial. Contraception. 1998; 58:207-210.
36- Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second- trimester abortion. Obstet Gynaecol. 1997; 90:896-900.
37- Herabutya Y, O-Prasertsawat P. Second trimester abortion using intravaginal misoprostol. Int Gynaecol Obstet 1998; 60:161-165.
38- Bugalho A, Bique C, Almeida L, Faundes A. The effectiveness of intravaginal misoprostol (Cytotec) in inducting abortion after eleven weeks of pregnancy. Stud Fam Plann. 1993; 24:319-323.
39- Elhassan E M, Abubaker MS, Adam I. Sublingual compared with oral vaginal misoprostol for termination of pregnancy with second-trimester fetal demise. Int Gynaecol Obstet. 2008; 100:82-83.
40- Chen M, Shih JC, Chiu WT, Hsieh FJ. Separation of cesarean scar during second-trimester intravaginal misoprostol abortion. Obstet Gynaecol. 1999; 94: 840-840.
41- Phillips K, Berry C, Mathers AM. Uterine rupture during second- trimester termination pregnancy using mifepristone and a prostaglandin. Eur J Obstet Gynaecol Reprod Biol. 1996; 65:175-176.
42- Fletcher HM, Mitchell S, Simeon D, Frederick J, Brown D. Intravaginal misoprostol as a cervical ripening agent. Br J Obstet Gynaecol. 1993;100:641¬644
43- Ngai SW, To WK, Lao T, Ho Pc. Cervical priming with oral misoprostol in pre-labor rupture of membranes at term. Obstet Gynecol. 1996; 87:923-¬926.
44- Kramer RL, Gilson GJ, Morrison DS, Martin D, Gonzales JL, Qualls CR. A randomized trial of misoprostol and oxytocin for induction of labor: safety and efficacy. Obstet Gynecol 1997; 89:387-391.
45- Sanchez-Ramos L, Chen AH, Kaunitz AM, Gaudier FL, Deike I. Labor induction with intravaginal misoprostol in term premature rupture of membranes: a randomized study. Obstet Gynecol 1997; 89: 909-912.
46- Wing DA, Paul RH. Induction of labor with misoprostol for premature rupture of membranes beyond thirty-six weeks' gestation. Am J Obstet Gynecol 1998; 179:94-99.
47- Varaklis K, Gumina R, Stubblefield PG. Randomized controlled trial of vaginal misoprostol and intracervical prostaglandinE2 gel for induction of labor at term. Obstet Gynecol 1995; 86: 541-544.
48- Wing DA, Rahall A, Jones MM, Goodwin TM, Paul RH. Misoprostol: an effective agent for cervical ripening and labor induction. Am J Obstet Gynecol 1995; 172: 1811-1816.
49- Wing DA, Jones MM, Rahall A, Goodwin TM, Paul RH. A comparison of misoprostol and prostaglandinE2 gel for preinduction cervical ripening and labor induction. Am J Obstet Gyneco1 1995; 172:1804-1810.
50- Buser D, Mora G, Arias F. A randomized comparison between misoprostol and dinoprostone for cervical ripening and labor induction in patients with unfavorable cervices. Obstet Gyneco1 1997; 89:581-585.
51- Surbek DV, Boesiger H, Hoesli I, Pavic N, Holzgreve W. A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandinE2 to induce labor. Am J Obstet Gynecol 1997; 177:1018-1023.
52- Gottschall DS, Borgida AF, Mihalek JJ, Sauer F, Rodis JF. A randomized clinical trial comparing misoprostol with prostaglandinE2 gel for preinduction cervical ripening. Am J Obstet Gynecol 1997; 177: 1067-1070.
53- Kolderup L, McLean L, Grullon K, Safford K, Kilpatrick S1. Misoprostol is more efficacious for labor induction than prostaglandinE2, but is it associated with more risk? A m J Obstet Gyneco1 1999;180: 1543-1550.
54- Sanchez-Ramos L, Kaunitz AM, Wears RL, Delke I, Gaudier F1. Misoprostol for cervical ripening and labor induction: a meta-analysis. Obstet Gynecol 1997; 89:633-642.
55- Hofmeyr GJ, Gulmezoglu AM. Vaginal misoprostol for cervical ripening and labour induction in late pregnancy (Cochrane review). In: Cochrane Library database, issue 3. Oxford, England: Cochrane Update Software, 2000.
56- Hofmeyr GJ, Gulmezoglu AM, Alfirevic Z. Misoprostol for induction of labour: a systematic review. Br J Obstet Gynaecol. 1999;106: 798-803.
57- Wing DA, Paul RH. A comparison of differing dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and labor induction. Am J Obstet Gynecol 1996; 175: 158-64.
58- Wing DA, Ortiz-Omphroy G, Paul RH. A comparison of intermittent vaginal administration of misoprostol with continuous dinoprostone for cervical ripening and labor induction. Am J Obstet Gynecol. 1997; 177:612-618.
59- Elhassan E M, Mirghani OA, Adam I. Misoprostol vs. oxytocin for induction of labour. Int Gynaecol Obstet.2005;91: 254-255.
60- Elhassan EM, Mirghani OA, Adam I. Intravaginal misoprostol vs. denoprostone as cervical ripening and labor-inducing agents. Int Gynaecol Obstet. 2004; 85:285-286.
61- Adam I, Hassan OA, Elhassan E M. Oral misoprostol vs. vaginal misoprostol for cervical repining and labour induction. Int Gynaecol Obstet . 2005; 89: 142-143.
62- Elhassan E M, Mirghani OA, Adam I. Cervical ripening and labor induction with 25 mg vs. 50 mg of intravaginal misoprostol. Int Gynaecol Obstet. 2005; 90:234-235.
63- Elhassan E M, Nasr A M, Adam I. Sublingual compared with oral and vaginal misoprostol for labor induction. Int Gynaecol Obstet. 2007; 97:153-154.
64-TK LO, Wl Lau, KS Wong, LCH Tang. Sublingual misoprostol compared to artificial rupture of membranes plus oxytocin infusion for labour induction in nulliparous women with a favorable cervix at term. Hong Kong Med J; 2006:12,345-350.
65- Bugalho A, Bique C, Machungo F, Faundes A. Induction of labor with intravaginal misoprostol in intrauterine fetal death. Am J Obstet Gynecol 1994; 171:538-541.
66- Bugalho A, Bique C, Machungo F, Bergstrom S. Vaginal misoprostol as an alternative to oxytocin for induction of labor in women with late fetal death. Acta Obstet Gynecol Scand 1995; 74:194-198.
67- Bennett BB. Uterine rupture during induction of labor at term with intravaginal misoprostol. Obstet Gynecol. 1997; 89:832-833.
68- Wing DA, Lovett K, Paul RH. Disruption of prior uterine incision following misoprostol for labour induction in women with previous cesarean delivery. Obstet Gynecol 1998; 91:828-830.
69- Plaut MM, Schwartz ML, Lubarsky S1. Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section. Am J Obstet Gynecol. 1999; 180:1535-1542.
70- El-Refaey H, O'Brien P, Morafa W, Walder J, Rodeck C. Use of oral misoprostol in the prevention of postpartum haemorrhage. Br J Obstet Gynaecol. 1997; 104:336-339.
71- Bamigboye AA, Hofmeyr GJ, Merrell DA. Rectal misoprostol in the prevention of postpartum hemorrhage: a placebo-controlled trial. Am J Obstet Gynecol 1998; 179:1043-1046.
72- Hofmeyr GJ, Nikodem VC, de Jager M, Gelbart BR. A randomised placebo controlled trial of oral misoprostol in the third stage of labour. Br J Obstet Gynaecol. 1998; 105:971-975.
73- Surbek DV, Fehr PM, Hosli I, Holzgreve W. Oral misoprostol for third stage of labor: a randomized placebo-controlled trial. Obstet Gynecol. 1999; 94:255-258
74- O'Brien P, EI-Refaey H, Gordon A, Geary M, Rodeck CH. Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study. Obstet Gynecol. 1998; 92:212-214.
2- Rayburn WF. A physician’s prerogative to prescribe drugs for off-label uses during pregnancy. Obstet Gynecol 1993; 81:1052-1055.
3- Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD. Absorption Kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol 1997; 90:88-92.
4- Foote EF, Lee DR, Karim A, Keane WF, Halstenson CE. Disposition of Misoprotol and its active metabolite in patients with normal and impaired renal function. J Clin Pharmacol 1995; 35:384-389.
5- Ulmann A, Silvestre L. RU486: the French experience. Hum Reprod 1994; 9:Suppl 1:126-130.
6- El-Refaey H, Templeton A. Induction of abortion in the second trimester by a combination of misoprostol and mifepristone: a randomized comparison between two misoprostol regimens. Hum Reprod 1995;10:475-478.
7- Danielsson KG, Marions L, Rodriguez A, Spur BW, Wong PY, Bygdeman M. Comparison between oral vaginal administration of misoprostol on uterine contractility. Obstet Gynecol. 1999; 93:275-280.
8- Creinin MD, Darney PD. Methotrexate and misoprostol for early abortion. Contraception 1993;48: 339-348.
9- Toppozada MK, Anwar MY, Hassan HA, el-Gazaerly WS. Oral or vaginal misoprostol for induction of labor. Int J Gynaecol Obstet. 1997; 56:135-139.
10- G.D. Searle, to the editor. N Engl J Med. 2001; 4: 334:361.
11- Goldberg AB, Greenberg MB, Darney PD. Misoprostol and pregnancy. N Engl J Med 2001;334:38-47.
12- Induction of labour with misoprostol. ACOG committee opinion no.228. Washington, D.C.
13- Induction of labour. ACOG practice bulletin no.10. Washington, D.C.: American College of Obstetrician and Gynecologists, November 1999.
14- Stitely ML, Browsing J, Fowler M, Gendron RT, Gherman RB. Outpatient cervical ripening with intravaginal misoprostol. Obstet Gynecol 2000;96: 684-688.
15- Off label use of Misoprostol. 2000 American College of Obstetrician and Gynecologists 2000; 44:9.
16- W E Mackenzie. Misoprostol-Letters in the Lancet. 2001;13:3.
17- Marsden Wagner. Misoprostoland the politics of fear. The Lancet 2001;13:3.
18- Carbonell JL, Varela L, Velazco A, Fernandez C. The use of misoprostol for termination of early pregnancy. Contraction 1997;55:165-168.
19- Ngai SW, Tang OS, Chan YM, Ho PC. Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation: efficacy and acceptability. Hum Reprod 2000;15:1159-1162.
20- Creinin MD, Moyer R, Guido R. Misoprotol for medical evacuation of early pregnancy failure. Obstet Gynecol. 1997;89: 768-772.
21- Zalanyi S. Vaginal misoprostol alone is effective in the treatment of missed abortion. Br J Obstet Gynaecol. 1998; 105:1026-1028.
22- Herabutya Y, O-Prasertsawat P. Misoprotol in the management of missed abortion. Int J Gynaecol Obstet. 1997; 65:263-266.
23- Henshaw RC, Cooper K, el-Refaey H, Smith NC, Templeton AA. Medical management of miscarriage: non-surgical uterine evacuation of incomplete and inevitable spontaneous abortion. BMJ 1993;306:894-5
24- De Jonge ET, Makin JD, Manefeldt E, De Wet GH, Pattinson RC. Randomized clinical trail of medical evacuation and surgical curettage for incomplete miscarriage. BMJ 1995; 311:662-662.
25- Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA 1984; 251:2108-2111.
26- Schulz KF, Grimes DA, Cates WJ Jr. Measures to prevent cervical injury during suction curettage abortion. Lancet 1983; 1: 1182-1185.
27- El-Refaey H, Calder L, Wheatley DN, Templeton A. Cervical priming with prostaglandinEl analogues, misoprostol and gemeprost. Lancet 1994; 343: 1207-9.
28- Maclsaac L, Grossman D, Balistreri E, Darney P. A randomized controlled trail of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynaecol. 1999; 93: 766-770.
29- Singh K, Fong YF, Prasad RN, Dong F. Randomized trail to determine optimal dose of vaginal misoprostol for per-abortion cervical priming. Obstet Gynaecol. 1998; 92:795-798.
30- Bugalho A, Bique C, Almeida L, Bergstrom S. Application of vaginal misoprostol before cervical dilatation to facilitate first-trimester pregnancy interruption. Obstet Gynaecol. 1994; 83: 729-731.
31- Singh K, Fong YF, Prasad RN, Dong F. Evaluation interval after vaginal misoprostol for pre-abortion cervical priming: a randomized trail. Obstet Gynaecol. 1999; 94:431-434.
32- Jain JK, Mishell DR Jr. A comparison of intravaginal misoprostol with prostaglandinE2 for termination of second-trimester abortion. N Engl J Med 1994; 331:290-293.
33- Jain JK, Mishell DR Jr. A comparison of misoprostol with and without laminaria tents for induction of second-trimester abortion. Am J Obstet Gynaecol. 1996; 175:173-177.
34- Jain JK, Kou J, Mishell DR Jr. A comparison of two dosing regimens of intravaginal misoprostol for second-trimester pregnancy termination. Obstet Gynaecol. 1999; 93:571-575.
35- Wong KS, Ngai CS, Wong AY, Tang LC, Ho PC. Vaginal misoprostol compared with vaginal gemeprost in termination of second trimester pregnancy: a randomized trial. Contraception. 1998; 58:207-210.
36- Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second- trimester abortion. Obstet Gynaecol. 1997; 90:896-900.
37- Herabutya Y, O-Prasertsawat P. Second trimester abortion using intravaginal misoprostol. Int Gynaecol Obstet 1998; 60:161-165.
38- Bugalho A, Bique C, Almeida L, Faundes A. The effectiveness of intravaginal misoprostol (Cytotec) in inducting abortion after eleven weeks of pregnancy. Stud Fam Plann. 1993; 24:319-323.
39- Elhassan E M, Abubaker MS, Adam I. Sublingual compared with oral vaginal misoprostol for termination of pregnancy with second-trimester fetal demise. Int Gynaecol Obstet. 2008; 100:82-83.
40- Chen M, Shih JC, Chiu WT, Hsieh FJ. Separation of cesarean scar during second-trimester intravaginal misoprostol abortion. Obstet Gynaecol. 1999; 94: 840-840.
41- Phillips K, Berry C, Mathers AM. Uterine rupture during second- trimester termination pregnancy using mifepristone and a prostaglandin. Eur J Obstet Gynaecol Reprod Biol. 1996; 65:175-176.
42- Fletcher HM, Mitchell S, Simeon D, Frederick J, Brown D. Intravaginal misoprostol as a cervical ripening agent. Br J Obstet Gynaecol. 1993;100:641¬644
43- Ngai SW, To WK, Lao T, Ho Pc. Cervical priming with oral misoprostol in pre-labor rupture of membranes at term. Obstet Gynecol. 1996; 87:923-¬926.
44- Kramer RL, Gilson GJ, Morrison DS, Martin D, Gonzales JL, Qualls CR. A randomized trial of misoprostol and oxytocin for induction of labor: safety and efficacy. Obstet Gynecol 1997; 89:387-391.
45- Sanchez-Ramos L, Chen AH, Kaunitz AM, Gaudier FL, Deike I. Labor induction with intravaginal misoprostol in term premature rupture of membranes: a randomized study. Obstet Gynecol 1997; 89: 909-912.
46- Wing DA, Paul RH. Induction of labor with misoprostol for premature rupture of membranes beyond thirty-six weeks' gestation. Am J Obstet Gynecol 1998; 179:94-99.
47- Varaklis K, Gumina R, Stubblefield PG. Randomized controlled trial of vaginal misoprostol and intracervical prostaglandinE2 gel for induction of labor at term. Obstet Gynecol 1995; 86: 541-544.
48- Wing DA, Rahall A, Jones MM, Goodwin TM, Paul RH. Misoprostol: an effective agent for cervical ripening and labor induction. Am J Obstet Gynecol 1995; 172: 1811-1816.
49- Wing DA, Jones MM, Rahall A, Goodwin TM, Paul RH. A comparison of misoprostol and prostaglandinE2 gel for preinduction cervical ripening and labor induction. Am J Obstet Gyneco1 1995; 172:1804-1810.
50- Buser D, Mora G, Arias F. A randomized comparison between misoprostol and dinoprostone for cervical ripening and labor induction in patients with unfavorable cervices. Obstet Gyneco1 1997; 89:581-585.
51- Surbek DV, Boesiger H, Hoesli I, Pavic N, Holzgreve W. A double-blind comparison of the safety and efficacy of intravaginal misoprostol and prostaglandinE2 to induce labor. Am J Obstet Gynecol 1997; 177:1018-1023.
52- Gottschall DS, Borgida AF, Mihalek JJ, Sauer F, Rodis JF. A randomized clinical trial comparing misoprostol with prostaglandinE2 gel for preinduction cervical ripening. Am J Obstet Gynecol 1997; 177: 1067-1070.
53- Kolderup L, McLean L, Grullon K, Safford K, Kilpatrick S1. Misoprostol is more efficacious for labor induction than prostaglandinE2, but is it associated with more risk? A m J Obstet Gyneco1 1999;180: 1543-1550.
54- Sanchez-Ramos L, Kaunitz AM, Wears RL, Delke I, Gaudier F1. Misoprostol for cervical ripening and labor induction: a meta-analysis. Obstet Gynecol 1997; 89:633-642.
55- Hofmeyr GJ, Gulmezoglu AM. Vaginal misoprostol for cervical ripening and labour induction in late pregnancy (Cochrane review). In: Cochrane Library database, issue 3. Oxford, England: Cochrane Update Software, 2000.
56- Hofmeyr GJ, Gulmezoglu AM, Alfirevic Z. Misoprostol for induction of labour: a systematic review. Br J Obstet Gynaecol. 1999;106: 798-803.
57- Wing DA, Paul RH. A comparison of differing dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and labor induction. Am J Obstet Gynecol 1996; 175: 158-64.
58- Wing DA, Ortiz-Omphroy G, Paul RH. A comparison of intermittent vaginal administration of misoprostol with continuous dinoprostone for cervical ripening and labor induction. Am J Obstet Gynecol. 1997; 177:612-618.
59- Elhassan E M, Mirghani OA, Adam I. Misoprostol vs. oxytocin for induction of labour. Int Gynaecol Obstet.2005;91: 254-255.
60- Elhassan EM, Mirghani OA, Adam I. Intravaginal misoprostol vs. denoprostone as cervical ripening and labor-inducing agents. Int Gynaecol Obstet. 2004; 85:285-286.
61- Adam I, Hassan OA, Elhassan E M. Oral misoprostol vs. vaginal misoprostol for cervical repining and labour induction. Int Gynaecol Obstet . 2005; 89: 142-143.
62- Elhassan E M, Mirghani OA, Adam I. Cervical ripening and labor induction with 25 mg vs. 50 mg of intravaginal misoprostol. Int Gynaecol Obstet. 2005; 90:234-235.
63- Elhassan E M, Nasr A M, Adam I. Sublingual compared with oral and vaginal misoprostol for labor induction. Int Gynaecol Obstet. 2007; 97:153-154.
64-TK LO, Wl Lau, KS Wong, LCH Tang. Sublingual misoprostol compared to artificial rupture of membranes plus oxytocin infusion for labour induction in nulliparous women with a favorable cervix at term. Hong Kong Med J; 2006:12,345-350.
65- Bugalho A, Bique C, Machungo F, Faundes A. Induction of labor with intravaginal misoprostol in intrauterine fetal death. Am J Obstet Gynecol 1994; 171:538-541.
66- Bugalho A, Bique C, Machungo F, Bergstrom S. Vaginal misoprostol as an alternative to oxytocin for induction of labor in women with late fetal death. Acta Obstet Gynecol Scand 1995; 74:194-198.
67- Bennett BB. Uterine rupture during induction of labor at term with intravaginal misoprostol. Obstet Gynecol. 1997; 89:832-833.
68- Wing DA, Lovett K, Paul RH. Disruption of prior uterine incision following misoprostol for labour induction in women with previous cesarean delivery. Obstet Gynecol 1998; 91:828-830.
69- Plaut MM, Schwartz ML, Lubarsky S1. Uterine rupture associated with the use of misoprostol in the gravid patient with a previous cesarean section. Am J Obstet Gynecol. 1999; 180:1535-1542.
70- El-Refaey H, O'Brien P, Morafa W, Walder J, Rodeck C. Use of oral misoprostol in the prevention of postpartum haemorrhage. Br J Obstet Gynaecol. 1997; 104:336-339.
71- Bamigboye AA, Hofmeyr GJ, Merrell DA. Rectal misoprostol in the prevention of postpartum hemorrhage: a placebo-controlled trial. Am J Obstet Gynecol 1998; 179:1043-1046.
72- Hofmeyr GJ, Nikodem VC, de Jager M, Gelbart BR. A randomised placebo controlled trial of oral misoprostol in the third stage of labour. Br J Obstet Gynaecol. 1998; 105:971-975.
73- Surbek DV, Fehr PM, Hosli I, Holzgreve W. Oral misoprostol for third stage of labor: a randomized placebo-controlled trial. Obstet Gynecol. 1999; 94:255-258
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Published
2008-12-01
How to Cite
ELHASSAN M.D, Elhassan M..
The Use of Misoprsotol in Pregnancy.
Gezira Journal of Health Sciences, [S.l.], v. 4, n. 2, dec. 2008.
ISSN 1810-5386. Available at: <http://37.60.236.48/index.php/gjhs/article/view/238>. Date accessed: 03 june 2026.
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