Misoprostol

• Medical management of miscarriage (with mifepristone)
• Medical termination of pregnancy
• Cervical ripening before IOL
• PPH (rectal, 3rd-line)

PGE1 receptor agonism → cervical softening + myometrial contractions. Dose & route alter onset/duration.

• 200 mcg PO — mifepristone-paired EMA
• 400 mcg SL/PV — miscarriage / TOP
• 600 mcg PO — PPH prevention (low-resource)
• 800 mcg PV/SL — missed miscarriage

Missed miscarriage

800 mcg PV or SL, repeat at 24–48 h if needed

Incomplete miscarriage

600 mcg PO or 400 mcg SL single dose

IOL (term)

25 mcg PV or 50 mcg PO q4h (per protocol)

PPH (off-label)

800–1000 mcg PR

• AbsolutePrevious classical CS / uterine surgery (for IOL doses)
• AbsoluteKnown allergy to prostaglandins
• CautionAsthma — generally safe (PGE1) but monitor

• Cramping, bleeding
• Diarrhoea, nausea, vomiting
• Fever, chills (dose-dependent)
• Tachysystole

• • Highly teratogenic in continuing pregnancy — Möbius sequence, limb defects.
• • Pregnancy MUST be confirmed non-viable before use for miscarriage management.

• Oxytocin

  Caution

  Wait ≥4 h after misoprostol before oxytocin (tachysystole)

• Magnesium-containing antacids

  Caution

  ↑ diarrhoea

• 💡 Stable at room temperature — WHO essential medicine.
• 💡 Counsel on expected bleeding/cramping timeline (4–6 h after vaginal dose).