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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 ...
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]
The use of misoprostol has been extensively studied but normally in small, poorly defined studies. Only a very few countries have approved misoprostol for use in induction of labor. [citation needed] Intravenous (IV) administration of synthetic oxytocin preparations is used to artificially induce labor if it is deemed medically necessary. [1]
Misoprostol: an analogue of PGE1, this PG is a popular choice for PPH prophylaxis and treatment. Misoprostol is easily administered, considered safe, and is low cost. The routes of administration include sublingual, oral, vaginal, and rectal with greatest efficacy from sublingual and vaginal administration.
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.
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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Prostaglandin E 2 (PGE 2) achieves cervical ripening and softening by stimulating uterine contractions as well as directly acting on the collagenase present in the cervix to soften it. [7] There are currently two formulations of PGE 2 analog available for use in cervical ripening: Prepidil, a vaginal gel, and Cervidil, a vaginal insert. [24]