DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163021

Severe morbidity with sublingual misoprostol in a post-partum patient: a case report

Sunita Verma, Binni Makkar, Netra Singh, Poonam Singh, Shefali Bansal

Abstract


Misoprostol is highly useful in preventing and treating postpartum hemorrhage. However, it may be associated with side effects like fever, chills and vomiting. Rarely may it cause severe morbidity and even death. We witnessed a case of 30 year old female, who developed postpartum hemorrhage immediately after her delivery. Patient was administered various uterotonics including 800 mcg sublingual misoprostol, with which her PPH was finally controlled. However, she developed hyperthermia, hypotension, tachycardia and fall in saturation of O2, after few hours of misoprostol administration. Patient was managed by strict monitoring in ICU setting and mechanical ventilation. She gradually recovered over a period of 48 hours and was discharged in stable condition. Misoprostol should be carefully used as it has a potential to cause serious adverse effects in pregnant and postpartum phase.

Keywords


Misoprostol, Sublingual

Full Text:

PDF

References


WHO Guidelines for the management of postpartum hemorrhage and retained placenta. Geneva: World Health Organization; 2009.

WHO recommendations for induction of labor. Geneva: World Health Organization; 2011.

HøjL, Cardoso P, Nielsen BB, Hvidman L, Nielsen J, Aaby P. Effect of sublingual misoprostol on severe postpartum haemorrhage in a primary health centre in Guinea-Bissau: randomized double blind clinical trial. BMJ. 2005;331(7519):723.

Derman RJ, Kodkany BS, Goudar SS, Geller SE. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006;368(9543):1248-53.

Chong YS, Su LL. Misoprostol for preventing PPH: some lessons learned. Lancet. 2006;368(9543):1216-8.

Hofmeyr GJ, Nikodem C, de Jager M, Drakely A. Side effects of oral misoprostol in the third stage of labour- a randomised controlled trial. S Afr Med J. 2001;91:432-5.

Zieman M, Fong SK, Benowitz L, Bansker D, Darney PD. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997;90:88-92.

Durocher J, Bynum J, Ledn W, Barrera G, Winkoff B. High fever following postpartum administration of sublingual misoprostol. BJOJ. 2010;117(7):845-52.

Chong YS, Chua S, Arulkumaran S. Misoprostol for preventing PPH: some lessons learned. Lancet. 2006;368(9543):1216-8.

Kaiser J, Royer PA. Profound hyperthermia after post- partum rectal misoprostol administration. Obstet Gynecol. 2016;127(6):1067-9.

Hofmeyr GJ, Gülmezoglu AM, Novikova N, Linder V, Ferreira S, Piaggio G. Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects. Bull World Health Organ. 2009;87(9):666-77.

Walraven G, Blum J, Dampha Y, Sowe M, Morison L, Winikoff B, et al. Misoprostol in the management of the third stage of labor in the home delivery setting in rural Gambia: a randomized controlled trial. BJOG. 2005;112(9):1277-83.

León W, Durocher J, Barrera G, Pinto E, Winikoff B. Dose and side effects of sublingual misoprostol for treatment of postpartum hemorrhage: what difference do they make? BMC Pregnancy Childbirth. 2012;12:65.