Misoprostol Use in Obstetric Practice: Indications, Efficacy, and Safety

Abstract

Background: Misoprostol, a synthetic counterpart of prostaglandin E1, is commonly used in obstetrics and gynecology for its uterotonic and cervical-ripening effects. It increases cervix softening and dilation by activating uterine smooth muscle contraction and allowing collagen to degrade in cervical tissue. Because cervical stenosis and difficult dilatation are prevalent problems during hysteroscopy, pharmacological cervical preparation has received more attention. Misoprostol has been studied as a pre-procedural drug to facilitate hysteroscope insertion, shorten procedure time, and reduce problems associated with mechanical cervical dilation. Before the procedure, various routes of administration, such as oral, vaginal, sublingual, and buccal, were investigated, with variable dosages and timing. Although numerous trials show greater cervical dilatation and simpler hysteroscope entrance, data on the appropriate dose, route, and time of administration are conflicting. Furthermore, misoprostol may cause stomach cramps, nausea, diarrhea, fever, and vaginal bleeding. As a result, assessing the efficacy and safety of misoprostol in cervical preparation before hysteroscopy remains therapeutically important.