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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 ...
Misoprostol is more commonly available than mifepristone, and is easier to store and administer, so misoprostol without mifepristone may be suggested by the provider if mifepristone is not available. [9] If misoprostol is used without mifepristone, the WHO recommends 800 μg of misoprostol inside the cheek, under the tongue, or in the vagina. [18]
Vaginally administered misoprostol had improved outcomes of inducing labor within twenty four hours compared to oxytocin, but was associated with uterine hyperstimulation. [15] Misoprostol is an agonist of EP1 and EP3 receptors, and can cause a greater stimulation at lower concentrations.
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]
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Prostaglandin E 2 (PGE 2), also known as dinoprostone, is a naturally occurring prostaglandin with oxytocic properties that is used as a medication. [2] [3] [4] Dinoprostone is used in labor induction, bleeding after delivery, termination of pregnancy, and in newborn babies to keep the ductus arteriosus open.
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Early medical abortion regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%. [64] [68] If medical abortion fails, surgical abortion must be used to complete the procedure. [69]