WHO recommendations for misoprostol use for obstetric and gynecologic indications.

Tang J, Kapp N, Dragoman M, de Souza JP
Int J Gynaecol Obstet 2013;121:186-189.
NATA Rating :
Review by : C. Breymann
NATA Review

Misoprostol, a prostaglandin E1 analog, was first marketed in the 1980s to prevent gastric ulcers. Today it is well known that one of the main “side effects” of misoprostol is the stimulation of uterine contractility and its influence on cervical ripening. This implies that misoprostol can be used for various gynecological and obstetric indications such as induction of labor, prevention of postpartum hemorrhage (PPH), management of PPH in case of uterine atony, and early and late medically and surgically induced abortion

It should be noted that even if misoprostol is on the WHO list for essential medicines, its use remains “off label” since there is no official regulatory indication for the use of misoprostol in the fields of obstetrics and gynecology, mainly due to legal and producing companies issues. This also means also that a patient treated with misoprostol should be informed that the use is an off label one, in order to avoid legal challenges case of negative side effects (such as uterine rupture secondary to hypercontractility). Having said that, it is clear that misoprostol has many advantages such as its high degree of effectiveness and good tolerance in recommended dosages in the various settings where it is used. In addition, it is cheap and easy to handle and can be easily stored, an advantage in developing countries and remote areas. Therefore, it is a most important alternative and adjunct to the classic substances such as oxytocine, sulprostone, methergine and other prostaglandins.

Every obstetrician who is dealing with induction of labor, induced abortion, PPH and birth should be aware and informed about the correct use of misoprostol in these settings. It is a great merit of this review that the main indications for the use of misoprostol and the respective dosages and routes of application (e.g., oral, rectal, vaginal) are summarized and listed, and can be checked easily prior to administration. Not only every specialist in our field but also nurses, midwives and health personnel should be informed about this list.

– Christian Breymann