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Misoprostol also may be used in conjunction with oxytocin. [24] Between 2002 and 2012, a misoprostol vaginal insert was studied, and was approved in the EU. [25] [26] [27] It was not approved for use in the United States, and the US FDA still considers cervical ripening and labor induction to be outside of the approved uses for misoprostol. [28 ...
The mifepristone-misoprostol combination is, by far, the most recommended drug regimen for medical abortions, but other drug combinations are available. Misoprostol alone, without mifepristone, may be used in some circumstances for medical abortion, and has even been demonstrated to be successful in the second trimester. [37]
Mifepristone combined with misoprostol is the preferred medication regimen for management of early pregnancy loss. While misoprostol alone can be used, the addition of a dose of mifepristone twenty-four hours before misoprostol administration improves treatment efficacy. [28]
Third, due to the nature of the cervical effacement process, enzymes and other mediators that regulate allergic and inflammatory responses are also involved. [6] One of the immunomodulating factors, mast cells, is known to secrete inflammatory mediators that modulate the process of cervical ripening through mast cell degranulation. [8]
Dilation and evacuation can be offered for the management of second trimester miscarriage if skilled providers are available. [6] Some women choose D&E over labor induction for a second trimester loss because it can be a scheduled surgical procedure, offering predictability over labor induction, or because they find it emotionally easier than undergoing labor and delivery.
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Cervical dilation can be performed by temporarily stretching the cervix with a series of (cervical) dilators of increasing diameter. [10] Misoprostol prior to hysteroscopy for cervical dilation appears to facilitate an easier and uncomplicated procedure only in premenopausal women.
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