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Induction Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Although it is currently on the market as a 100-mg tablet to prevent peptic ulcers, misoprostol is available and widely used in an “off-label” form for preinduction cervical ripening and induction. Misoprostol should not be used for cervical ripening or labor induction in women with prior uterine incisions (e.g. prior CD) after 28 weeks [16, 19]. For use of misoprostol for induction in the second trimester, see Chap. 57 in Maternal-Fetal Evidence Based Guidelines. Misoprostol can be administered vaginally, orally, buccally, or sublingually.
Fetal Death
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Available evidence from randomized trials do support the use of vaginal misoprostol as a medical treatment to terminate nonviable pregnancies before 24 weeks of gestation [69, 70]. Therefore, for gestations less than 28 weeks, misoprostol is the most efficient method of induction, regardless of Bishop score, although high-dose oxytocin infusion is an acceptable alternative [31]. Typical dosages for misoprostol use are 200–400 µg vaginally, orally, or 200 µg buccal every 4–12 hours [31]. Examples of regimens for misoprostol dosing are 200 µg vaginally every 4 hours, 400 µg vaginally every 3–4 hours, or 600 µg vaginally every 12 hours. Buccal route can also be used. These result in successful expulsion (mostly within 24 hours) in 80–100% of cases [31, 71–77]. A Cochrane systematic review evaluated prostaglandins for termination of pregnancy in the second or third trimester, and found that vaginal misoprostol is as effective as other prostaglandin preparations, as well as being more effective than oral misoprostol [78]. Misoprostol 600 µg administered vaginally at 12-hour intervals is associated with fewer adverse effects and is as effective as dosing at 6-hour interval [76].
Post-Partum Haemorrhage
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
AMTSL can reduce the risk of PPH by 60% and must be followed universally. Organization for a programme for appropriate technology in health (PATH) and WHO has advocated Oxytocin Uniject (is a plastic ampule containing ten units of oxytocin with a sterile needle covered by a plastic sheath that can be easily twisted and removed) for all low-resource settings. Uniject does not require injection skills and can be administered by the paramedical workers as well. In the low-resource peripheral units where uniject is not available, misoprostol must be available and used for every woman after delivery of the fetus unless contraindicated.
Oral misoprostol tablets (25 µg) for induction of labor: a targeted literature review and cost analysis
Published in Journal of Medical Economics, 2022
Anne-Claire Poinas, Katherine Padgett, Roel de Heus, Franck Perrotin, Roland Devlieger
Misoprostol is a synthetic prostaglandin E1 analogue22. It is sold under the brand name Cytotec (Pfizer Inc, Groton, CT) and other brand names, and is indicated for the treatment of gastric and duodenal ulcers23. Misoprostol is among the options recommended by the WHO and has commonly been used off-label for IOL; however, off-label use is associated with various concerns. Cytotec is formulated as 200 µg tablets, but the dosing required for IOL is either 25 or 50 µg per dose. There is no single protocol for the preparation of the correct dose, and practitioners use differing preparation methods and dosing regimens24. Cutting up the tablet is difficult to do precisely and may lead to dosing inaccuracy25,26. Further, compounded Cytotec deteriorates rapidly and therefore has a short shelf life27. Correct misoprostol dosing is vital to ensure efficacy and safety and minimize adverse events28. Too high a dose can increase the risk of uterine hyperstimulation29, too low a dose can lead to ineffective induction30. Because of the risk of negative outcomes associated with off-label use, Cytotec has been withdrawn for all indications in France due to safety concerns23,31, and is subject to warnings and restrictions in other countries32,33.
Titrated oral misoprostol versus static regimen of oral misoprostol for induction of labour: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Saeed Baradwan, Majed Saeed Alshahrani, Khalid Khadawardi, Ehab Badghish, Waleed H. Alkhamis, Doaa Fathy Mohamed, Shaimaa Hanafy Moustafa Kamal, Hala Waheed Abdel Halim, Eman A. Alkholy, Mariam Salah Mohamed, Asmaa Abdelaal Mohamed, Shaimaa Ali Barakat, Hagar Abdelgawad Magdy, Eman Ibrahim Abd Elrehim, Ahmed Mohamed Abdelhakim, Bassem Ragab, Saged Mohamed Metyli Elmazzaly, Mostafa Ellaban, Ahmed M. Abbas, Ghada Ibrahim Soror
Many organisations have accepted misoprostol administration as a safe method for the management of different labour aspects such as cervical ripening, induction of labour, and postpartum haemorrhage prevention (Tang et al. 2013; Alfirevic et al. 2014). Many reasons have led to the universal use of misoprostol, including its low cost, stability at room temperature, and their different routes of administration, especially the widely accepted oral route (Rouzi et al. 2014; Voigt et al. 2015). In comparison with oxytocin, oral misoprostol has been suggested to be effective and safe for labour induction (Bricker et al. 2008; Mbaluka et al. 2014). Since vaginal misoprostol increases the risk of ascending infection, most physicians prefer to administer oral misoprostol in comparison with vaginal misoprostol (Hofmeyr et al. 2010).
Ibuprofen-based advanced therapeutics: breaking the inflammatory link in cancer, neurodegeneration, and diseases
Published in Drug Metabolism Reviews, 2021
Arun Upadhyay, Ayeman Amanullah, Vibhuti Joshi, Rohan Dhiman, Vijay Kumar Prajapati, Krishna Mohan Poluri, Amit Mishra
The other effective way of reducing the risks caused by NSAIDs in patients who are suffering from rheumatoid arthritis is selective antagonism of receptors for PGE2 and PGE4 (Clark et al. 2008; Chen et al. 2010). These antagonists suppress the development of helper T cells and reduce the overall inflammatory response by interfering with their penetration to the site of tissue damage (Nakao et al. 2007; Takeuchi et al. 2007). Synthesizing the NSAID derivatives with a considerable anti-cancer properties and better gastrointestinal tolerance is an additional possible mechanism of improving the applicability of these drugs (Elsaman and Ali 2016). Designing prodrugs are one such example where an enhanced water solubility, with greater NO or H2S release and better antioxidant properties, is presented by the modified chemical compounds (Qandil 2012). Several other possible ways of reducing the risks of gastrointestinal injuries, e.g. co-drug therapies, have been proposed in the past that have shown potential, with some limitations during various experimental studies. For example, the use of Misoprostol significantly reduces gastrointestinal complications, like duodenal ulcers, in arthritis patients taking NSAIDs medications (Graham et al. 1993; Silverstein et al. 1995).