Misoprostol - PPT 1
Misoprostol - PPT 1
Misoprostol - PPT 1
Sources of Evidence
Pub Med
Cochrane library
Misoprostol Clinical Guideline WHO
Misoprostol :Topics
Misoprostol An off label drug Pharmacokinetic Profiles
Misoprostol Is An
Why?
It has an effect the best available PGs Inexpensive. Stable at room temperature.
pharmacokinetic profiles of
the misoprostol
2009
15
16
PG E1
1
16
15
Misoprostol
(Cytotec, Mesotac,Misoprost )
Sublingual 11 min
Vaginal
Rectal
20 min
100 min
4 h
4 h
Misoprostol
Side effects
Mild Diarrhea, Vomiting, Abdominal pain, Fever, Shivering 5-60% Uterine contractile abnormalities: Fetal: Distress & its sequels. Maternal: Uterine rupture & bleeding
A child with oromandibular-limb hypogenesis-Mbius syndrome. Notice the expressionless face (due to bilateral VII nerve palsies) and missing fingers
Bos- Thompson, Ann Pharmacother. 2008 Jun;42(6):888-92.
2009
Versus Vacum ?
WHO Clinical Guidelines Bellagio, Italy in Feb 2009 Blumenthal et al., Int J Gynecol Obstet(2007) 99, (supp 2):S178-81.
Dilatation &Evacuation .
. In the pipeline:
Isprelor - 25g vaginal tablets, UK
Ruptured membranes.
WHO Clinical Guidelines Bellagio, Italy in Feb 2009 Gmez Ponce de Len et al., Int J Gynecol Obstet(2007) 99, (supp 2):S190.
further 24-H
WHO Clinical Guidelines Bellagio, Italy in Feb 2009 Gmez Ponce de Len et al., Int J Gynecol Obstet(2007) 99, (supp 2):S190.
Postpartum Haemorrhage
1000 ug sublingual
Vaginal delivery:
Grade A
Grade C
Recommended Dosages
600 g orally or sublingually
Where injectible conventional uterotonics are not available.
Second dose (for continued atonic hemorrhage): preferably 2 h after the original dose or 6 h if there is pyrexia or marked shivering . WHO Clinical Guidelines Bellagio, Italy in Feb 2009 Gmez Ponce de Len et al., Int J Gynecol Obstet(2007) 99, (supp 2):S190. FIGO October 2009
Recommended Dosages
600 g orally or sublingually.
Misoprostol should be used only after the provider has exhausted all standard PPH treatments (oxytocin drip, uterine massage, and/or compression).
All potential causes for PPH should be explored to assure that the PPH is not due to another factor besides uterine atony.
WHO Clinical Guidelines Bellagio, Italy in Feb 2009 Gmez Ponce de Len et al., Int J Gynecol Obstet(2007) 99, (supp 2):S190.
Conclusions
dose if previous CS
dose if previous CS
Thank You