From the Guidelines
Misoprostol should be administered at a dose of 600-800 micrograms after birth to prevent or treat postpartum hemorrhage, with the specific dose and route of administration determined by the healthcare provider based on individual patient needs and clinical guidelines. The medication can be administered sublingually (under the tongue), orally, rectally, or vaginally, with sublingual or oral routes being most common for postpartum use [ 1 ]. For prevention of postpartum hemorrhage, a single dose of 600 micrograms is often recommended, while for treatment of established bleeding, 800 micrograms may be used. The medication works by causing the uterus to contract, which helps to control bleeding from the site where the placenta was attached.
Key Considerations
- Side effects may include shivering, fever, nausea, vomiting, and diarrhea [ 1 ].
- It's essential that misoprostol be administered by or under the supervision of healthcare providers who can monitor for excessive bleeding and other complications.
- The medication typically takes effect within 10-20 minutes when given sublingually or orally.
- If bleeding continues despite misoprostol use, additional interventions may be necessary, and medical help should be sought immediately.
Administration and Monitoring
- Healthcare providers should carefully assess the patient's condition and medical history before administering misoprostol [ 1 ].
- The patient should be closely monitored for signs of excessive bleeding, such as heavy vaginal bleeding, dizziness, or fainting.
- In cases where bleeding continues or worsens despite misoprostol use, additional treatments, such as tranexamic acid or blood transfusions, may be necessary [ 1 ].
From the Research
Dosage for Misoprostol after Birth
- The dosage of misoprostol after birth varies across studies, with different routes of administration and dosages being used.
- A study published in 2009 found that 800 microg of rectal misoprostol was effective in reducing blood loss after delivery 2.
- Another study published in 2010 used 800 microg of sublingual misoprostol to treat post-partum haemorrhage, and found it to be clinically equivalent to intravenous oxytocin 3.
- A study published in 2014 used 400 mcg of oral misoprostol, and found that it may be considered as an alternative for oxytocin in low resource clinical settings 4.
- A study published in 2016 used 400 micrograms of oral misoprostol, but found that it did not reduce the rate of postpartum hemorrhage risk and increased the rate of adverse events when administered with prophylactic routine oxytocin 5.
- The use of misoprostol in combination with other uterotonics, such as oxytocin, has been found to have an additive or synergistic effect in preventing postpartum hemorrhage 6.