Which medications in the drug class Prostaglandin are used in the treatment of Early Pregnancy Loss in Emergency Medicine?

Updated: Nov 05, 2018
  • Author: Slava V Gaufberg, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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These agents induce uterine contractions.

Misoprostol (Cytotec)

Not approved for use in pregnancy, yet is an invaluable medication widely used for cervical preparation for miscarriage, labor induction, and as a medical abortifacient. Provides safe, passive method of cervical dilatation and should be considered for facilitation of passage of products of conception in the setting of inevitable or incomplete miscarriage, preabortion ripening when prior uterine surgery (ie, LEEP, cesarean delivery) are known risk factors for uterine perforation during surgical abortion. Can be administered orally or vaginally. Some studies show premoistened tablets placed vaginally help absorption. Patients can be instructed in self-administration to help time the dose in synchrony with their abortion procedure.

In a study by Singh of primigravid women (6-11 wk gestation), 93.3% achieved dilatation of the cervix of 8 mm or greater after 3 h postintravaginal misoprostol 400 mcg, whereas only 16.7% of women achieved this after 2 h of 600 mcg. The 600-mcg group had slightly greater adverse effects (eg, bleeding, abdominal pain, fever >38ºC).

Dosage intended for cervical ripening can induce abortion in some patients. Oral doses of 100-400 mcg can be combined with vaginal insertion of prostaglandins to enhance cervical dilatation.

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