Research Update: Misoprostol—Is More Research Needed?

Misoprostol (Cytotec) is a synthetic prostaglandin E1 analogue that was designed for the prevention and treatment of peptic ulcer associated with the use of nonsteroidal anti-inflammatory drugs. In obstetrics, misoprostol has been administered for induction of first and second trimester abortion, for induction of labor in the third trimester, and to control postpartum hemorrhage. None of these uses has been approved by the Food and Drug Administration. Nevertheless, misoprostol is widely used in the United States and throughout the world. Advantages are cited as reduced rate of cesareans, shorter time from induction to birth and, particularly in developing countries, lower cost, oral, vaginal or rectal administration, and stability without refrigeration. Disadvantages are uterine hyperstimulation and, in rare instances, uterine rupture and death. Mothers should be informed of both the risks and the possible benefits of misoprostol. Further research with large samples is necessary to determine whether the risks outweigh any possible benefits.