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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]
Cervical ripening using dinoprostone vaginal inserts have the same rates of neonatal morbidity, caesarean section, and labor onset when used in the outpatient setting and the inpatient setting. [20] Evidence for use of misoprostol in the outpatient versus inpatient setting was insufficient to draw conclusions.
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 ]
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. [30]
Cervical dilation can be performed by temporarily stretching the cervix with a series of (cervical) dilators of increasing diameter. [11] Misoprostol prior to hysteroscopy for cervical dilation appears to facilitate an easier and uncomplicated procedure only in premenopausal women.
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.
Osmotic dilators are most commonly used to slowly dilate and soften the cervix prior to surgical abortion, a process referred to as cervical preparation. Adequate cervical preparation is important prior to surgical abortions because it helps to prevent complications of dilation and evacuation (D&E), such as laceration of the cervix. [ 5 ]