Short interpregnancy interval and misoprostol as additive risks for uterine rupture: a case report.
Henderson Cassandra E,Hana Romany Gawargious,Woroch Roman,Reilly Kevin D
The Journal of reproductive medicine
BACKGROUND:Short interpregnancy interval and uterine instrumentation are risk factors for uterine rupture in subsequent pregnancies. Misoprostol as a uterotonic agent is an additive risk factor for rupture of a scarred uterus. CASE:Misoprostol induction for a term stillbirth was complicated by uterine rupture. Risk factors for this uterine rupture might have included interpregnancy intervals of < 7 months, prior uterine instrumentation, and misoprostol as a uterotonic agent. CONCLUSION:Caution and a high index of suspicion are warranted when using misoprostol as a uterotonic agent after a short interpregnancy interval.
Misoprostol for miscarriage management in a woman with previous five cesarean deliveries: a case report and literature review.
AlSaad Doua,Alobaidly Sawsan,Abdulrouf Palli,Thomas Binny,Ahmed Afif,AlHail Moza
Therapeutics and clinical risk management
BACKGROUND:Misoprostol is an effective medical method for the management of pregnancy loss. However, data on its efficacy and safety in women with previous cesarean deliveries are limited. CASE PRESENTATION:We report a 36-year-old patient, gravida 11 para 6, with a diagnosis of missed miscarriage at 15 weeks of gestation. The patient had a significant obstetric history of previous five cesarean deliveries and uterine rupture. Following patient counseling about the medical and surgical options of managing her miscarriage, the patient opted for medical method. Low-dose misoprostol of 100 µg was inserted vaginally and repeated again after 6 hours. The patient had an uneventful complete miscarriage following the second dose of misoprostol. No uterine rupture, no extra vaginal bleeding, and no blood transfusion were observed. CONCLUSION:We conclude that adopting a low-dose misoprostol protocol could be potentially safe and effective in managing second trimester missed miscarriage in women with repeated cesarean deliveries and/or uterine rupture history. Further studies are needed to confirm these results.
10.2147/TCRM.S132294
How much misoprostol is safe? - First reported case of second-trimester uterine rupture after a single low dose.
Datta S,Minocha S
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
With the rising rate of caesarean births, the scenario of fetal demise occurring in a woman with previous caesarean births is becoming more prevalent. The optimal mode of management of intrauterine fetal demise in women with multiple caesarean births presents a challenge for the obstetricians due to absence of a definite protocol with good efficacy, safety and acceptability in these women. The risks of hysterotomy have to be balanced against the risk of uterine rupture with induction. Misoprostol is one of the most common drugs being used in mid-trimester miscarriage but with variable doses. The reports of uterine rupture with previous caesarean scar are rare and have occurred with different doses, making it difficult to counsel women regarding maternal risks. It is difficult to conduct a randomised control trial to address this issue due to limited number of patients and therefore no drug or dosage can be recommended with certainty. We present a unique and first case of second-trimester uterine rupture in a woman with three previous caesarean births and intrauterine fetal demise, after a single low dose of 25 μg vaginal misoprostol. This highlights the need for further research in context of misoprostol dosage in women with more than two previous caesarean births having second-trimester induction of labour.
10.3109/01443615.2015.1072808
Misoprostol Induced Expulsion of Fetus Following Diagnosis of Anencephaly on Ultrasound: A Case Report.
Shrestha Hari Kishor,Koirala Suphatra,Shrestha Ingima
JNMA; journal of the Nepal Medical Association
Anencephaly is a condition in which there is an absence of skull and brain tissues. Absence of cranial vault mainly results because of defective neurulation. Absence of cerebral tissues may cause diminished heart size, due to decreased heart load causing various cardiac abnormalities. Here, we report a case of a primigravida lady at 17 weeks of gestation with misoprostol induced expulsion of fetus after ultrasonography revealed absence of brain tissue and calvarium above the orbits suggesting anencephaly. A 300g fetus was delivered which confirmed the ultrasound findings. The patient was discharged with advice for intake of folic acid beginning from 3 months before conception in future pregnancies. Neural tube defects can manifest within approximately 28 days of gestation which highlights the importance of oral folic acid intake before pregnancy.
10.31729/jnma.6402
Uterine perforation as a rare complication of attempted pregnancy termination with misoprostol: a case report.
Lialios Georgios,Kallitsaris Athanasios,Mademtzis Jordan,Messinis Ioannis E
The Journal of reproductive medicine
BACKGROUND:Abortion induced by drugs is now a viable alternative to surgically induced abortion, but it can cause severe complications. CASE:Products of conception were found in the peritoneal cavity after administration of misoprostol. CONCLUSION:The administration of misoprostol for pregnancy termination should be performed carefully in women with uterine wall defects.
Unscarred uterine rupture after induction of labor with misoprostol: a case report.
Akhan S E,Iyibozkurt A C,Turfanda A
Clinical and experimental obstetrics & gynecology
The rupture of an unscarred uterus is very rare and presents an emergency situation that threatens the life of the fetus and mother. The agents used for induction of labor, like oxytocin and/or prostaglandins, can be responsible for this catastrophic event. We report a case of intrapartum rupture of an intact uterus after using intravaginal misoprostol for cervical ripening and labor induction in a term pregnancy and we discuss the other cases reported in the literature.
[Moebius syndrome due to the use of misoprostol. Case report].
Sánchez Otto,Guerra Dania
Investigacion clinica
We report a patient affected with Moebius Syndrome (OMIM 157900) due to the use of misoprostol during the first trimester of the pregnancy, when abortion was intended twice using this drug, vias vaginal (600 mg) and oral (900 mg), with failure to induce abortion on both occasions. Since the use of misoprostol for abortion, without any medical indication or supervision, appears to be rather frequent in our population and since there are reports of severe malformations in children born after failed intents of abortion with this medication, it is necessary to alert the medical community and the population in general about the teratogenic risks of this drug.
Disseminated intravascular coagulation following induction of labour with misoprostol: a case report.
Umar N I,Abdul M A,Jido T A,Tukur J,Dattijo L M
Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria
BACKGROUND:Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness, low cost, stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect, uterine rupture and post partum haemorrhage (PPH) have been documented. METHOD:This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use. RESULT:This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100 microg of misoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously, then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. CONCLUSION:Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC.
10.4314/njm.v17i2.37374
Unusual Posterior Wall Uterine Rupture with the Use of Misoprostol for Second Trimester Pregnancy Termination.
Mariye Yitbarek Fantahun,Weldetensay Eskinder Kebede,Dribisa Weyesa
Ethiopian journal of health sciences
Abortion is defined as the termination of pregnancy before the fetus is viable. It is one of the most commonly performed procedures in gynecological departments worldwide. Termination of pregnancy in second trimester is one of the greatest challenges because of multiple modes of termination options with their risks of complication and making it riskier than the first trimester termination. We report this case because of a rare occurrence of posterior wall rupture which would have led to grave complication if not anticipated and detected early.
10.4314/ejhs.v32i1.23
Maternal death related to misoprostol overdose.
Henriques Alexandra,Lourenço Alexandre V,Ribeirinho Ana,Ferreira Helena,Graça Luís M
Obstetrics and gynecology
BACKGROUND:Misoprostol is an important drug in obstetrics and gynecology because of its uterotonic and cervical-ripening activities. The side effects are dose-related, usually transitory, and well tolerated. The toxic dosage in humans is unknown, and there is no specific antidote. CASE:An adolescent developed upper gastrointestinal bleeding after self-medication with misoprostol orally (12 mg) to cause abortion. She presented with multiorgan failure, acute abdominal signs, and hemodynamic instability. Emergency laparotomy showed gastric and esophageal necrosis. After several episodes of cardiac arrest, and despite resuscitation efforts, the patient died. CONCLUSION:Temporal relationship (48 hours after the beginning of medication) strongly suggests that misoprostol was the agent directly involved in the maternal death. The mechanism implicating misoprostol in gastrointestinal ischemia and necrosis is unknown.
10.1097/01.AOG.0000253248.64065.94
Silent uterine rupture with the use of misoprostol for second trimester termination of pregnancy : a case report.
Cuellar Torriente Martin
Obstetrics and gynecology international
Uterine rupture is an uncommon, but a life-threatening, complication following second trimester medical termination of pregnancy (TOP). The reported cases have been in both the scarred and unscarred uterus (Rajesh et al. 2002, Drey et al. 2006, and Dickinson). A 27-year-old with two previous deliveries, no previous caesarean section, no history of induced abortions, and no gynaecological operations. She presented with amenorrhoea, and according to her last normal menstruation, she was 10 weeks and 5 days. Ultrasound was done, and it reported 16 weeks and 5 days. She asked for TOP. According to the clinic's protocol, misoprostol 800 mcg (4 tabs) were given to be used vaginally as a loading dose and another three to be taken orally after that. In the following day when she attended the clinic for follow up, a manual vacuum aspiration (MVA). A manual vacuum aspiration was indicated as an incomplete abortion. During the procedure, a uterine rupture was found in the uterine lower segment. A laparotomy was done and a lineal uterine rupture was found and sutured. The patient had a good postoperative recovery and was discharged from hospital after four days. The clinician dealing with second trimester terminations should be aware of the possibility of having a uterine rupture, especially in patients with a uterine scar in order to make an early diagnosis.
10.1155/2011/584652
[Misoprostol-induced pneumonitis].
Matsumoto T,Nakamura K,Sugisaki K,Shigenaga T,Miyazaki E,Sawabe T,Abe Y,Tsuda T
Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society
A 76-year-old woman presented with non-productive cough and progressive dyspnea, and was admitted to Oita Medical University Hospital. Arterial blood gas values obtained on admission indicated severe hypoxemia. Chest roentgenograms and computed tomography disclosed diffuse interstitial infiltrates in both lungs. Transbronchial lung biopsy specimens demonstrated thickened alveolar walls with lymphocyte infiltration and swollen type II pneumocyte proliferation. Eosinophils were observed mainly around bronchioles. For approximately 6 months prior to hospitalization, the patient had been given misoprostol, sodium aurothiomalate, prednisolone, and loxoprofen sodium for the treatment of rheumatoid arthritis. Based on the clinical history and findings, drug-induced interstitial pneumonia was suspected. All medications were discontinued, and the patient was then placed on corticosteroids. After treatment, arterial blood gas values improved and the findings on chest roentgenograms cleared up. Positive lymphocyte stimulation tests and positive dermal reaction patch tests implicated misoprostol as an etiologic factor in the patient's interstitial pneumonia. High serum levels of KL-6 and cytokeratin subunit 19 fragment had been detected on admission. These values returned to normal after the interstitial infiltrates had disappeared. To our knowledge, this is the first reported case of misoprostol-induced interstitial pneumonia.
Uterine Scar Dehiscence Associated with Misoprostol Cervical Priming for Surgical Abortion: A Case Report.
Stitely Michael L,Craw Sue,Africano Enrique,Reid Rosemary
The Journal of reproductive medicine
BACKGROUND:Cervical priming prior to pregnancy termination is a common treatment. Both osmotic agents such as laminaria and Dilapan or pharmacologic agents such as misoprostol and mifepristone have been used for this purpose. CASE:A 30-year-old patient with a previous cesarean delivery was undergoing surgical termination of pregnancy at 13 weeks' gestation for a lethal fetal malformation. During preoperative cervical priming with misoprostol the uterine scar dehisced. Interval laparoscopic repair was performed. CONCLUSION:Uterine scar dehiscence can occur with misoprostol preoperative cervical priming for second trimester surgical termination of pregnancy.
Oral misoprostol and uterine rupture in the first trimester of pregnancy: a case report.
Kim Joo Oh,Han Jung Yeol,Choi June Seek,Ahn Hyun Kyong,Yang Jae Hyug,Kang Inn Soo,Song Mi Jin,Nava-Ocampo Alejandro A
Reproductive toxicology (Elmsford, N.Y.)
We are reporting the case of a woman with 8 weeks of amenorrhea who orally received a single dose of misoprostol 400 microg at midnight for ripening of cervix before uterine evacuation of an intrauterine gestational sac containing a single fetus (6.3 weeks of gestation) without cardiac activity. The patient had severe abdominal pain an hour later. Her blood pressure was 70/40 mmHg and her abdomen was slightly distended with direct and rebound tenderness. A transvaginal ultrasonography showed a 3-cm depth of a free fluid collection in the rectouterine pouch. Her hemoglobin and hematocrit levels were of 6.5 g/dL and 18.4%, respectively. A rupture of 1.5 cm at the left uterine horn with a protruding gestational sac was identified by laparoscopy. The gestational sac was removed and hemoperitoneal collection were successfully drained. The site of uterine rupture was primarily sutured and postoperative course was satisfactory. In summary, misoprostol administered in the first trimester of pregnancy may produce uterine rupture.
10.1016/j.reprotox.2005.04.014
Uterine rupture in a nulliparous woman.
Onstad Solveig Karbø,Miltenburg Andrea Solnes,Strøm-Roum Ellen Marie
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke
BACKGROUND:Previous caesarean section is considered the main risk factor for uterine rupture. However, other surgical procedures performed on the uterus can also lead to rupture in future pregnancies. CASE PRESENTATION:The patient was a nulliparous woman, induced at gestational age of 41 + 6 with misoprostol. She developed severe persistent abdominal pain. Due to fetal bradycardia, an acute caesarean section was performed. Peroperatively a large rupture was identified in the uterine fundus and the placenta was detached into the abdomen. Medical history included a previous rightsided salpingectomy due to an extrauterine pregnancy located in the interstitial part of the right Fallopian tube. INTERPRETATION:Interstitial extrauterine pregnancy is rare, and recommendations for mode of delivery for subsequent pregnancies remain unclear. The current case illustrates the importance of being aware of the risk of rupture when the patient has undergone previous gynaecological surgery other than caesarean section, and of ensuring awareness of the placenta's location.
10.4045/tidsskr.21.0085
Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug.
Shin Hyun Joo,Lee Sa Ra,Roh A-Mi,Lim Young-Mee,Jeong Kyung Ah,Moon Hye-Sung,Chung Hye Won
Obstetrics & gynecology science
Misoprostol is widely used in daily practice for induction of labor and cervical dilatation prior to intrauterine procedures, including dilatation and curettage or hysteroscopy. Anaphylactic shock to intravaginal misoprostol can occur not only in pregnant women, as reported in 2 previous cases, but also in a non-pregnant, perimenopausal woman, as in the case described herein. A 49-year-old woman received vaginal misoprostol for cervical ripening prior to hysteroscopic myomectomy and experienced anaphylactic shock. Two 400 μg doses of misoprostol 6 hours apart caused uncontrolled shaking and high fever followed by shock. In conclusion, the possibility of anaphylactic shock should be considered in patients with sudden hypotension following misoprostol administration. Prompt identification and management are crucial to prevent morbidity and mortality following an anaphylactic shock to misoprostol.
10.5468/ogs.2018.61.5.636
Misoprostol Induced Convulsion-A Rare Side Effect of Misoprostol.
Sharma Nalini,Das Rituparna,Ahanthem Santa Singh,Reddy Kalyani
Journal of clinical and diagnostic research : JCDR
Misoprostol, a synthetic prostaglandin E1 has wider application in obstetrics gynaecology. It has been recommended in the prophylaxis and treatment of Post Partum Haemorrhage (PPH) by Federation of Obstetrics and Gynaecology (FIGO), World Health Organisation (WHO) and American College of Obstetrics and Gynaecology (ACOG). It is a very safe drug associated with transient side-effects like fever, chills, nausea, vomiting, diarrhoea and abdominal pain. In the present case report patient had an unusual side effect of hyperpyrexia and convulsion after use of misoprostol for prophylaxis against PPH.
10.7860/JCDR/2017/23396.9189
Misoprostol-augmented induction of labour for third trimester fetal demise in a patient with prior hysterotomies.
BMJ case reports
A 31-year-old G3P2002 with history of two prior caesarean sections presented with influenza-like illness, requiring intubation secondary to acute respiratory distress syndrome. Investigations revealed intrauterine fetal demise at 30-week gestation.She soon deteriorated with sepsis and multiple organs impacted. Risks of the gravid uterus impairing cardiopulmonary function appeared greater than risks of delivery, including that of uterine rupture. Vaginal birth after caesarean was achieved with misoprostol and critical care status rapidly improved.Current guidelines for management of fetal demise in patients with prior hysterotomies are mixed: although the American College of Obstetricians and Gynecologists recommends standard obstetric protocols rather than misoprostol administration for labour augmentation, there is limited published data citing severe maternal morbidity associated with misoprostol use. This case report argues misoprostol-augmented induction of labour can be a reasonable option in a medically complex patient with fetal demise and prior hysterotomies.
10.1136/bcr-2020-239872
Anaphylaxis to buccal misoprostol for labor induction.
Schoen Corina,Campbell Sara,Maratas Amber,Kim Cheung
Obstetrics and gynecology
BACKGROUND:Misoprostol is a commonly used agent for induction of labor. Anaphylactic reactions are infrequent but possible complications of drugs administered to the pregnant patient. Although antibiotics, latex, and anesthetic agents are more common triggers for anaphylaxis, induction agents are also a rare cause. CASE:A 21-year-old woman received buccal misoprostol as a ripening agent for postdate labor induction and experienced anaphylaxis and tachysystole. Prompt administration of epinephrine and emergent cesarean delivery allowed for the safe delivery of the neonate and minimal maternal morbidity. CONCLUSION:When inducing labor, prompt identification and treatment of anaphylaxis and hypersensitivity reactions are necessary to prevent maternal and neonatal morbidity and mortality. Health care providers must be aware of uncommon reactions to medications used to induce labor.
10.1097/AOG.0000000000000268
Foetal fibular hemimelia with focal femoral deficiency following prenatal misoprostol use: A case report.
Pallavee P,Samal Rupal,Begum Jasmina,Ghose Seetesh
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
Misoprostol is a well known abortifacient. It can cause teratogenicity like Mobius sequence and terminal transverse limb defects. We report a rare case of proximal focal femoral deficiency with fibular hemimelia in a woman who had attempted abortion with self-administered misoprostol and later continued the pregnancy. Though the absolute risk of congenital malformations with its use is low ∼1%, this should be clearly communicated to the women requesting abortion to help them make fully informed reproductive health decisions.
10.3109/01443615.2016.1157152
Abortion failure after illegal use of misoprostol--a case report.
Rouzi Abdulrahim A
The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception
OBJECTIVE:To report on a unique medical situation after self-obtained use of misoprostol in a country where abortion is illegal. CASE:A 29-year-old woman was seen at 12 weeks' gestation with a history of use of 10,800 microg of misoprostol orally and vaginally over the preceding six weeks. She had experienced mild-to-moderate pelvic pain but no vaginal bleeding. Because the pregnancy was intrauterine and viable, surgical termination could not be carried out. The risks of fetal congenital anomalies due to in utero exposure to misoprostol were discussed with the patient. A detailed ultrasonography at 16 weeks' gestation revealed no anomaly. Vaginal delivery at 38 weeks' gestation resulted in the birth of a baby without discernible congenital anomalies. CONCLUSIONS:In countries where abortion is illegal, women should be informed about the risks associated with unsupervised self-induced abortion with misoprostol.
10.3109/13625187.2010.512672
A case report and literature review of myocardial infarction with nonobstructive coronary arteries (MINOCA) possibly due to acute coronary vasospasm induced by misoprostol.
Frontiers in cardiovascular medicine
Coronary artery vasospasm (CVS), an uncommon cause of acute chest pain, can be provoked by vasoconstriction-induced medications. Misoprostol, a prostaglandin analog, is a safe medication to terminate a pregnancy. However, misoprostol can cause coronary artery vasospasm due to vasoconstrictor properties, leading to acute myocardial infarction with nonobstructive coronary arteries (MINOCA), especially in patients with a high risk for cardiovascular disease. We report a case of a 42-year-old female with a past medical history of hypertension who presented with ST-elevation myocardial infarction following the administration of a high-dose Misoprostol. The fact that coronary angiogram and intravascular ultrasound revealed normal coronary arteries suggested transient coronary vasospasm. CVS is a severe but rare cardiac adverse effect associated with high-dose misoprostol. This medication should be prescribed with caution and close monitoring, especially in those with pre-existing heart disease or cardiovascular risk factors. Our case raises awareness of severe cardiovascular complications that can be related to using misoprostol in high-risk patients.
10.3389/fcvm.2023.1115358
Teratogenic effect of Misoprostol following failure of elective abortion: A case of femoral agenesis and review of the literature.
Radiology case reports
Misoprostol, a synthetic analogue of prostaglandin E1, is commonly used in gynecology, particularly in combination with mifepristone for elective abortion. Although its use is widespread, the potential teratogenic effects of misoprostol in cases of failed medical abortion have not been sufficiently explored in the medical literature. Severe congenital malformations, although rare, have been reported, raising concerns about the impact of this drug on fetal development. We present a rare case of femoral agenesis observed in a woman who experienced a failed medical abortion with Misoprostol (Cytotec®), highlighting the need for a better understanding of the risks associated with fetal exposure to this drug and the implementation of rigorous follow-up measures after its use.
10.1016/j.radcr.2024.09.133
A case of toxic shock due to clandestine abortion by misoprostol self-administration.
Cittadini Francesca,Loyola Giovanni,Caradonna Letizia,Minelli Natalia,Rossi Riccardo
Journal of forensic sciences
Maternal mortality and morbidity are the leading causes of death and illness, respectively, among women of reproductive age in many countries throughout the world. Of all maternal deaths, those related to unsafe abortions are the most widely underestimated, but they are also the most largely preventable. Medical abortion is a safe and reliable method for termination of a pregnancy in early gestation, although it is important to be aware of signs and symptoms of severe infection and toxic shock syndrome after the medical termination of pregnancy; case studies in literature are rarely fatal events. We report the first case of septic shock syndrome following a clandestine pregnancy termination with a misoprostol-only regimen (12 tablets 200 μg each). Autopsy findings and histopathological examination proved that the woman died from septic shock. This case suggests to improve the forensic investigations in case of unsafe, often clandestine, abortion is suspected.
10.1111/1556-4029.12536
Sublingual Misoprostol-Induced Rhabdomyolysis and Convulsions in Postpartum Hemorrhage: A Case Report and Literature Review.
Cureus
Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality, primarily attributed to uterine atony. Both the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) endorse the use of misoprostol not only for the prevention but also for the treatment of PPH. However, the administration of misoprostol is commonly associated with transient pyrexia, attributed to a shift in the hypothalamic set point observed in certain animal studies. Misoprostol-induced hyperpyrexia can occasionally manifest with a prodrome of shivering, particularly when administered via the sublingual route, which achieves a higher and faster maximum plasma concentration compared to vaginal and rectal routes. General management strategies to reduce fever involve removing clothing and blankets, applying cool compresses, administering oral acetaminophen, and ensuring adequate hydration. While some cases have reported misoprostol-induced convulsions, hyperpyrexia leading to convulsions and subsequent rhabdomyolysis is a rare and potentially lethal side effect. In this case presentation, we emphasize a scenario where misoprostol was employed for the treatment of PPH but led to rhabdomyolysis. Our goal is to highlight the side effects of misoprostol and the significance of considering the initial combination of misoprostol with anti-pyretic management to minimize the risk of hyperthermia-related side effects and prevent additional severe complications.
10.7759/cureus.59874
Misoprostol-induced Coronary Vasospasm Complicated by Takotsubo Cardiomyopathy and Cardiac Arrest.
European journal of case reports in internal medicine
Misoprostol is a synthetic E1 prostaglandin commonly used to induce abortion in the United States and elsewhere. There is limited literature on the cardiovascular adverse effects of misoprostol, and, to the best of our knowledge, very few such events have been reported. We describe the case of 52-year-old woman who was given misoprostol for cervical softening before endometrial ablation and experienced a cardiac arrest due to coronary vasospasm. She was successfully resuscitated and echocardiography showed features consistent with Takotsubo cardiomyopathy. Coronary angiography revealed coronary artery spasm which responded to nitroglycerin. Our case adds to the limited literature on this life-threatening adverse event of misoprostol. LEARNING POINTS:Misoprostol is frequently used obstetrics and gynaecology and routinely for the medical termination of pregnancy.Misoprostol can result in cardiac arrest due to coronary vasospasm.Coronary vasospasm induced by misoprostol can be relieved with intra-arterial nitroglycerin.
10.12890/2021_002674
Erythema Multiforme Associated With Misoprostol: A Case Report.
Sahraei Zahra,Mirabzadeh Mehran,Eshraghi Azadeh
American journal of therapeutics
A 33-year-old healthy woman at 6 weeks of gestation without any underlying disease developed erythema multiforme (EM) after misoprostol. She had no history of herpes simplex virus infection and drug allergy to nonsteroidal anti-inflammatory drugs and antibiotic agents. Medical abortion was performed at 6 weeks' gestation. Later day, the patient developed oral lesions as several white bullae lesions in her buccal mucosa and hyperkeratotic lip plaques with mild pain. Then, lesions resolved within approximately 3 weeks. Microscopic finding of oral biopsy from beneath the tongue and lesions was performed. The result was consistent with erosive mucosa with granulation tissue formation and acute inflammation in favor of EM. This is the case report of probable misoprostol-induced EM. Because EM may produce in skin as a Stevens-Johnson syndrome in subsequent attack, monitoring of this adverse drug reaction should be considered for proper management and follow-up.
10.1097/MJT.0000000000000193
Clinical guidelines-the challenges and opportunities: What we have learned from the case of misoprostol for postpartum hemorrhage.
Morris Jessica L,Khatun Samia
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
OBJECTIVE:To establish whether national guidelines for postpartum hemorrhage (PPH) reflect new scientific evidence on misoprostol, and determine the challenges faced in their implementation. METHODS:A web-based survey was sent by email to 130 national societies of obstetrics and gynecology (FIGO Member Associations) in 2016. The survey, composed of 18 questions, covered national guidelines on PPH with particular reference to misoprostol, the creation of national guidelines, and challenges to implementation. RESULTS:Completed surveys were received from 69 societies, for a 53% response rate. The key findings were that many countries lacked comprehensive, up-to-date, evidence-based national guidelines providing guidance on misoprostol use; recommended regimens were very different in the national guidelines as well as between international and regional guidelines that are most often used as referencing documents; and there are a variety of challenges to implementation of guidelines. CONCLUSION:There is a need, especially in countries with high maternal mortality, to establish mechanisms that ensure the existence of up-to-date, comprehensive, evidence-based guidelines on PPH. This can be difficult given conflicting guidance at the international level. Regional and international societies should prioritize clinical updates and ensure their dissemination and implementation.
10.1002/ijgo.12704
Sublingual misoprostol and hyperpyrexia: case report with temperature curve.
BMC research notes
BACKGROUND:Misoprostol has a wide range of applications in obstetrics and gynaecology. It is widely recommended by WHO, FIGO and ACOG for the treatment of postpartum haemorrhage due to it safety and cost-effectiveness. However, usage might be associated to hyperpyrexia and shivering. CASE PRESENTATION:We present a 30 year old Cameroonian female gravida 1 para 1 who had a vaginal delivery at 40 weeks of gestation complicated by primary postpartum haemorrhage (PPH). PPH was managed by sublingual misoprostol that induced shivering and hyperpyrexia managed successfully with paracetamol and cooling. CONCLUSIONS:The occurrence of fever and shivering should be kept in mind when administering misoprostol for PPH.
10.1186/s13104-017-2661-2
Toxic Epidermal Necrolysis Associated with Misoprostol: A Case Report.
International medical case reports journal
Misoprostol, a synthetic prostaglandin E1 analog, is currently used for medical termination of pregnancy. In the summary of the product characteristics of different market authorization holders of misoprostol tablets, approved by major regulators, serious mucocutaneous reactions, including toxic epidermal necrolysis are not documented as adverse effects. We are now reporting an unusual case of toxic epidermal necrolysis following the use of misoprostol 200 mcg tablets prescribed for termination of a pregnancy. A 25-year-old grand multipara woman from the Gash-Barka region of Eritrea visited Tesseney hospital with a history of amenorrhea that lasted for four months. She was admitted as a case of missed abortion for medical termination of pregnancy. Following three doses of misoprostol 200 mcg tablet the patient developed toxic epidermal necrolysis. Except misoprostol, no other possible alternatives that could explain the condition were identified. Accordingly, the adverse effect was judged to be possibly related to misoprostol. The patient recovered after four weeks of treatment without sequelae. Toxic epidermal necrolysis could, therefore, be a possible adverse effect of misoprostol that needs to be further investigated with better epidemiological studies.
10.2147/IMCRJ.S408342
Misoprostol-induced Acute Coronary Syndrome in a Premenopausal Woman: A Case Report with Literature Review.
Mazhar Faizan,Sultana Jabeen,Akram Shahzad
Current drug safety
BACKGROUND:Misoprostol is a synthetic analog of prostaglandin-E1 and it is the most widely used drug for the medical management of incomplete abortion. Acute Coronary Syndrome (ACS) rarely occurs in perimenopausal women, in addition, its presentation is atypical, so the disease is not always recognized. CASE REPORT:We describe a case of 39-year-old woman with no major underlying cardiovascular risk factors, who developed an episode of ACS following the administration of two doses of misoprostol. After the discontinuation of misoprostol treatment, there was a complete resolution of patient's symptoms. The case draws attention to a rare side effect of a commonly used drug and alerts the clinicians to be cautious in those patients having baseline risk factors which make the patient more susceptible to such serious adverse drug effect.
10.2174/1574886312666171122100929
[Misoprostol in case of termination of pregnancy in the second and third trimesters. Trials].
Pluchon M,Winer N
Journal de gynecologie, obstetrique et biologie de la reproduction
Termination of pregnancies (TOP), in the second and third trimesters, require feasibility to induce labour with unfavorable cervix. Combination therapy is then usually necessary. Misoprostol use is out of marketing authorization in obstetrics but is widely used for many years in TOP in the 2nd and 3rd trimesters of pregnancy. Most randomized trials comparing misoprostol to other molecules available for TOP (gemeprost, dinoprostone, sulprostone) show that misoprostol is at least as effective with fewer side effects often especially if using adapted doses and routes of administration. Sometimes, products with a marketing authorization have been used with caution due to adverse effects more or less reported with misoprostol. There is, however, no conclusive evidence in the literature showing the superiority of a dose or route of administration of misoprostol compared to another. However, sublingual and oral seem to be preferred by patients than the vaginal route which remains the most evaluated and effective route. In summary, the use of vaginal misoprostol is the first-line treatment in medical abortion in the 2nd and third trimester, in combination with at least 200mg of mifepristone 36 to 48 hours before, at a dose of 400 μg every 4 to 6 hours. However, its use must be given with caution in cases of uterine scar, but cannot be forbidden for the sole justification of not having a marketing authorization. It will nevertheless warrant information to patients and allow a reduction at least half doses. The multi-scarred uterus still justifies a lower starting dose in the minimum effective doses (100 μg or less) as a corollary, increased induction-expulsion delay. The risk-benefit balance must be discussed with the patient. The agent without any pharmacological action solely or in combination (laminar dilapans, Foley catheter or double balloon) is particularly interesting in the case of uterine scar or maternal vascular risk but requires further evaluation by other research with adequate power and methodology before recommending for systematic routine use.
10.1016/j.jgyn.2013.11.009
Reactions to Misoprostol: A Case Report.
Clinical medicine insights. Case reports
Background:Most of abortions occur before the 13th week of pregnancy. Nowadays, non-surgical approaches for evacuation of uterine have been replaced with surgical ones due to the reduction in bleeding, fewer complications, ease of management, and cost-effectiveness. Misoprostol is a prostaglandin E1 analog that is used for labor induction. It is known as a safe drug with very few side effects. Case Presentation:A 29-year-old woman with the gestational age of 11 weeks and 6 days with a diagnosis of cystic hygroma introduced herself to the labor ward. At the time of hospitalization, the patient was conscious. The heart sounds were normal. A vaginal exam indicated no pathological findings. Totally, she received 1000 mg of Misoprostol. Approximately, 2 hours after the last placement of Misoprostol, the patient developed bending and mild cyanosis of fingers and showed tachycardia with a pulse rate of 140 beats/min. Her O saturation decreased to 78%. At this time, the patient had a successful miscarriage. Echocardiography showed an ejection fraction of 55% and normal right ventricular size. The electrocardiogram showed sinus tachycardia. Therefore, she was sent to CCU with a possible diagnosis of embolism. The cardiologist administered a heparin drip of 5000-unit IV stat, and 1000 unit/h heparin and asked for a D-Dimer test. However, the laboratory reported that the patient's blood sample was hemolyzed and they could only check her hemoglobin which was 4 g/dl. Immediately, the heparin drip was held and the patient received 3 packed cells. Her Hb was 6.5 g/dl. 12 hours later she showed tachycardia, and her O saturation reduced to 70%. She lost her consciousness. Nearly 40 minutes later, she had cardiorespiratory arrest and CPR wasn't successful and she died. Conclusions:In Conclusion, even a frequently used drug such as Misoprostol can cause life-threatening side effects, leading to emergent situations.
10.1177/11795476231215903
A rare case of misoprostol hypersensitivity.
Journal of family medicine and primary care
Medical abortion using mifepristone-misoprostol regimen has been considered to be a safe and effective method for pregnancy termination. Misoprostol is a frequently used well tolerated drug with mild and transient side effects. Considering the safety profile mifepristone-misoprostol regimen has also been advocated by many for home-based medical abortion. However, we report herein a rare case of hypersensitivity reaction to sublingual misoprostol administered for first trimester medical abortion, where timely diagnosis and prompt intervention prevented life-threatening airway obstruction. The possibility of such rare event should be kept in mind and included in patient counselling and information especially for those who opt for outpatient abortion care so that they can seek medical help at the earliest.
10.4103/jfmpc.jfmpc_1301_21
Delirium in an elderly woman possibly associated with administration of misoprostol.
Morton M R,Robbins M E
DICP : the annals of pharmacotherapy
Misoprostol has been associated with adverse reactions, including gastrointestinal symptoms, gynecologic problems, and headache. Changes in mental status, however, have not been reported. We present a case in which an 89-year-old woman in a long-term care facility became confused after the initiation of misoprostol therapy. The patient's change in mental status was first reported nine days after the initiation of therapy. Her delirium significantly improved after misoprostol was discontinued and her mental status returned to normal within a week. Because no other factors related to this patient changed significantly, the delirium experienced by this patient possibly resulted from misoprostol therapy.
10.1177/106002809102500205