A randomised control trial of misoprostol use found a 38% reduction in maternal deaths due to post partum haemorrhage in resource-poor communities. Misoprostol is recommended due to its cost, effectiveness, stability, and low rate of side effects. Oxytocin must also be given by injection, while misprostol can be given orally or rectally for this use, making it much more useful in areas where nurses and physicians are less available. Insertion of intrauterine contraceptive device
In women with prior caesarean section or prior failure of insertion of an intrauterine contraceptive device, pre-procedure administration of misoprostol reduces the rate of failure of insertion of intrauterine contraceptive device. However, due to a higher rate of adverse effects, routine use of misoprostol for this purpose in other women is not supported by the data. Other
For cervical ripening in advance of endometrial biopsy to reduce the need for use of a tenaculum or cervical dilator.There is limited evidence supporting the use of misoprostol for the treatment of trigeminal neuralgia in patients with multiple sclerosis. Adverse effects
The most commonly reported adverse effect of taking misoprostol by mouth for the prevention of stomach ulcers is diarrhea.
Myomectomy
When administered prior to myomectomy in women with uterine fibroids, misoprostol reduces operative blood loss and requirement of blood transfusion. Abortion
Misoprostol is used either alone or in conjunction with another medication (mifepristone or methotrexate) for medical abortions as an alternative to surgical abortion. Medical abortion has the advantage of being less invasive, and more autonomous, self-directed, and discreet. It is preferred by some women because it feels more "natural," as the drugs induce a miscarriage. It is also more easily accessible in places where abortion is illegal. The World Health Organization provides clear guidelines on the use, benefits and risks of misoprostol for abortions.Misoprostol is most effective when it is used in combination with methotrexate or mifepristone (RU-486). Mifepristone inhibits the signals of pregnancy hormones, eventually causing the uterine lining to degrade, similar to a period, which cause the embryo to detach from the uterus walls. Misoprostol then dilates the cervix and induces muscle contractions which clear the uterus. Misoprostol alone is less effective (typically 88% up to eight-weeks gestation). It is not inherently unsafe if medically supervised, but 1% of women will have heavy bleeding requiring medical attention, some women may have ectopic pregnancy, and the 12% of pregnancies that continue after misoprostol failure are more likely to have birth defects and are usually followed up with a more effective method of abortion.Most large studies recommend a protocol for the use of misoprostol in combination with mifepristone. Together they are effective in around 95% for early pregnancies.