Misoprostol, as an E1 prostaglandin, is primarily used in obstetrics for cervical ripening (when the Bishop Score is under 6) and/or for labor INDUCTION (to begin labor). IV oxytocin is the principal agent used to augment labor, as needed, once labor has begun. In the US, misoprostol is not typically used after 4-6 cm cervical dilation. However, in a patient who requires augmentation, and who declines Pitocin while asking or oral misoprostol, can that be used? Is that evidence-based? The data may surprise you. Listen in for details.

1. SOGC Guideline No. 432c: Induction of Labour Robinson, Debbie Campbell, Kim Hobson, Sebastian R. MacDonald, W. Kim Sawchuck, Diane Wagner, Brenda et al.

Journal of Obstetrics and Gynaecology Canada , Volume 45, Issue 1, 70 - 77.e3

2. Bracken H, Lightly K, Mundle S, et al. Oral Misoprostol Alone Versus Oral Misoprostol Followed by Oxytocin for Labour Induction in Women With Hypertension in Pregnancy (MOLI): Protocol for a Randomised Controlled Trial. BMC Pregnancy and Childbirth. 2021;21(1):537. doi:10.1186/s12884-021-04009-8.

3. Bleich AT, Villano KS, Lo JY, et al. Oral Misoprostol for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2011;118(6):1255-1260. doi:10.1097/AOG.0b013e318236df5b.

4. Ho M, Cheng SY, Li TC. Titrated Oral Misoprostol Solution Compared With Intravenous Oxytocin for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2010;116(3):612-618. doi:10.1097/AOG.0b013e3181ed36cc.

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