Explanation:
Misoprostol is a synthetic prostaglandin E1 analog that can be administered vaginally, orally, or sublingually for cervical ripening and labor induction. Prostaglandins play an important role in cervical ripening by increasing inflammatory mediators in the cervix and inducing cervical remodeling. Misoprostol is currently approved by the FDA to prevent peptic ulcers, although it has been used off-label for induction and cervical ripening since 2002. It is available in a 100 mcg or 200 mcg tablet and can be broken into 25 mcg or 50 mcg doses. A 25 mcg dose of misoprostol can be given every 3–6 hours. Misoprostol in higher doses (50 mcg) should not be given more frequently than every 6 hours, as it can increase the risk of uterine tachysystole and fetal heart rate decelerations. The use of misoprostol in women with prior cesarean delivery or uterine surgery has been associated with an increase in uterine rupture and should be avoided in the third trimester.
Increased activity of phospholipase A2 (A) and prostaglandin F2 alpha (D) is associated with membrane stripping. Dinoprostone is a prostaglandin E2 (C) preparation in the form of a gel and an insert, and it is an effective method of induction.
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