Labor induction with misoprostol

Misoprostol, a prostaglandin E-1 analog, is widely used in the United State s for cervical ripening and labor induction. Its use for these indications is not approved by the US Food and Drug Administration. The only Food and D rug Administration-approved indication in the product labeling is the treat ment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory use. Multiple trials have proved that misoprostol is an effective agent for cervical ripening and labor induction in term pregnancy ; however, investigations continue regarding the optimal dose, dosing regim en, and route of administration. Uterine contraction abnormalities are ofte n found in association with higher misoprostol doses. Some trials also indi cate increased frequencies of meconium passage, neonatal acidemia, and cesa rean delivery for fetal distress in women receiving higher doses of misopro stol. Overall, most trials fail to demonstrate a significant change in the cesarean delivery rate with the use of this agent. Misoprostol is an effect ive agent for cervical ripening and labor induction when used in a judiciou s and cautious fashion.