[Use of misoprostol for induction of labor in case of fetal death or termination of pregnancy during second or third trimester of pregnancy: Efficiency, dosage, route of administration, side effects, use in case of uterine scar].

Abstract

OBJECTIVE:

Study, based on the literature, of the use of misoprostol for induction of labor in cases of second or third trimester fetal death or termination of pregnancy and define the different mode of administration.

MATERIALS AND METHODS:

Bibliographic review using the Medline and Pubmed databases and the guidelines of the international professional societies. Selection of papers in French and English. Keywords used: misoprostol, termination of pregnancy, mid and third trimester, scarred uterus, previous cesarean section, uterine rupture.

RESULTS:

Misoprostol is effective for induction of labor in case of second or third fetal death or termination of pregnancy. Comparing to oral route, vaginal route reduces the induction-expulsion time and the rate of patients remaining undelivered in the first 24 hours without increasing side effects. Oral route is a possible alternative if preferred by the patient. Sublingual route seems interesting but data are limited. The use of moderate doses (800-2400 μg/day) every 3 to 6 hours seems to be the best compromise between efficiency and tolerance. It is not possible to recommend a specific dosing schedule. The risk of uterine rupture in case of previous cesarean section justifies the use of minimum effective dose for these patients. In this case, it is recommended not to exceed a dose of 100 μg for each dose. The induction-birth period and doses of misoprostol required to induce labor are reduced when combined with mifepristone administered 36 to 48 hours before.

CONCLUSION:

Misoprostol is effective and safe for induction of labor in case of second or third trimester fetal death or termination of pregnancy.

• Authors: E Clouqueur, C Coulon, P Vaast, A Chauvet, P Deruelle, D Subtil, V Houfflin-Debarge
• Journal: Journal de gynecologie, obstetrique et biologie de la reproduction (J Gynecol Obstet Biol Reprod (Paris)) Vol. 43 Issue 2 Pg. 146-61 (Feb 2014) ISSN: 1773-0430 [Electronic] France
• Vernacular Title: Utilisation du misoprostol pour l'induction du travail en cas de MIU ou d'IMG au deuxième ou au troisième trimestre de la grossesse : efficacité, posologie, voie d'administration, effets secondaires, utilisation en cas d'utérus cicatriciel.
• PMID: 24461423 (Publication Type: English Abstract, Journal Article, Review)
• Copyright: Copyright © 2014. Published by Elsevier Masson SAS.

Chemical References

• Abortifacient Agents, Nonsteroidal
• Oxytocics
• Misoprostol

Topics

• Abortifacient Agents, Nonsteroidal
• Abortion, Induced (methods)
• Cesarean Section (adverse effects)
• Cicatrix
• Employment
• Female
• Fetal Death
• Humans
• Labor, Induced (adverse effects, methods)
• MEDLINE
• Misoprostol (administration & dosage, adverse effects)
• Oxytocics
• Pregnancy
• Pregnancy Trimester, Second
• Pregnancy Trimester, Third
• Risk Factors
• Uterine Rupture
• Uterus (pathology)