32 Misoprostol : Theory and Practice

Prostaglandins have revolutionalized obstetric practice. In particular, the advent of misoprostol has precipitated an enormous amount of innovative research as well as controversy. At present, misoprostol is being simultaneously investigated for its role in the management of postpartum hemorrhage (PPH), induction of labor, cervical ripening and termination of pregnancy. Initially, this drug was only approved by the US Food and Drug Administration (FDA) in 1988 for oral administration for the prevention and treatment of peptic ulcers associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs). Since the early 1990s, however, misoprostol has been viewed with increasing interest by obstetricians and gynecologists because of its uterotonic and cervical ripening activity. The multiple off-label uses for misoprostol, supported by a literature comprising thousands of individual articles, underlie its description as ‘one of the most important medications in obstetrical practice’1. Even as recently as 2005, misoprostol was not approved by the FDA for use in pregnant women, a stand strangely and yet strongly supported by its manufacturer2.