Mastering misoprostol: Comprehensive uses across trimesters

Contemporary OB/GYN:

Please provide an overview of your session at ACOG 2024.

Leanne R. McCloskey, MD:

So, our session at ACOG really focuses on the uses of misoprostol for the basic obstetrician across trimesters. So, we talked about use in the first trimester for early pregnancy loss, for medication abortion in the second trimester, for management of medical induction of labor, both for abortion as well as induction for stillbirth, and then in the third trimester…

Weronika A. Armstrong, MD:

We also discuss the use of misoprostol for stillbirth considerations in the early third trimester as well as at term, different protocols and safety concerns, as well as other considerations, given special circumstances, the use of misoprostol for induction of labor in that situation.

McCloskey:

I think something that's really important that we focus on as well is how the uses of misoprostol processes and protocols and ensuring that, you know, medical practices are appropriate. It's also how that can impact birth equity and maternal mortality and just satisfaction with your birth experience. I think that's a nice piece of our presentation, and that really brings everything full circle.

Armstrong:

That's right. So, we discussed protocols, but we also talk about the degree of shared decision making at every trimester, and how that is important to incorporate into your decision making is the patient's experience.

Contemporary OB/GYN:

What is the clinical significance of this topic?

Armstrong:

Incredible. Truly, it is the bread and butter of obstetrics and gynecology, it is something that a general OBGYN and sub specialist OBGYN, whether it's a maternal fetal medicine specialist, or a complex planner, has to manage every day in our jobs. And so, it's really important that people are up to date and utilizing the best evidence based guidelines for all of these trimesters.

Contemporary OB/GYN:

What are the key takeaways from the session?

McCloskey:

One, misoprostol can be used in any trimester starting from diagnosis of the pregnancy all the way to the delivery of the baby as well as even after if there was postpartum hemorrhage or anything like that. So, it has many uses via many routes, many doses throughout your entire pregnancy. So, it's important to kind of get an understanding of all of that.

Armstrong:

And in our opinion, misoprostol is the best prostaglandin for all those reasons, but also because it is really a cost effective option that you can apply in various different resource rich or poor settings.

Contemporary OB/GYN:

Can you highlight some considerations for misoprostol?

Armstrong:

I think it'd be difficult honestly, to summarize it here because there were such varying different doses and routes that depended on which trimester we're discussing. So it would be hard to sort of give like a one summary statement. But I would recommend, you know, looking into the society guidelines that we highlighted during our talk, and having those saved and or notes from those saved in a place that you can reach regularly, such that you are utilizing the best protocols consistently.