Misoprostol

Provider Level

RN/Paramedic

Class

Prostaglandin E1 analogue

Mechanism of Action

Synthetic prostaglandin E1 analogue that binds to myometrial cells to stimulate strong uterine contractions and cause cervical ripening, thereby reducing postpartum bleeding.

Indications

Severe postpartum hemorrhage unresponsive to fundal massage and first-line uterotonics (e.g., oxytocin).

Contraindications

Known hypersensitivity to prostaglandins. Presence of an undelivered fetus (e.g., unrecognized multiple gestation).

Routes

PO, SL, Buccal

Onset / Duration

Onset: 10 to 15 minutes. Duration: 2 to 3 hours.

Adverse Effects

Shivering, pyrexia (fever), nausea, vomiting, diarrhea, abdominal cramping, headache.

Precautions & Interactions

Use caution in patients with cardiovascular disease or active asthma, though it is generally safer than other prostaglandins. Fever and profound shivering are very common but usually transient.

Special Considerations

Must only be administered after the delivery of the infant(s). Ensure no additional fetuses remain in utero prior to administration. Commonly administered rectally in practice, though only indicated routes from the provided list are detailed.