Anaphylactic shock to vaginal misoprostol: a rare adverse reaction to a frequently used drug

Abstract

Misoprostol is widely used in daily practice for induction of labor and cervical dilatation prior to intrauterine procedures, including dilatation and curettage or hysteroscopy. Anaphylactic shock to intravaginal misoprostol can occur not only in pregnant women, as reported in 2 previous cases, but also in a non-pregnant, perimenopausal woman, as in the case described herein. A 49-year-old woman received vaginal misoprostol for cervical ripening prior to hysteroscopic myomectomy and experienced anaphylactic shock. Two 400 μg doses of misoprostol 6 hours apart caused uncontrolled shaking and high fever followed by shock. In conclusion, the possibility of anaphylactic shock should be considered in patients with sudden hypotension following misoprostol administration. Prompt identification and management are crucial to prevent morbidity and mortality following an anaphylactic shock to misoprostol.

Anaphylaxis to oral misoprostol in a term pregnant patient who is non-allergic to vaginal misoprostol-a case report

“…A case of anaphylactic shock and mycotic necrosis after treatment with artotec, a combination of diclofenac sodium with misoprostol has been reported whereas severe hypotension and anaphylactic shock was reported after receiving vaginal misoprostol for cervical ripening prior to hysteroscopic myomectomy. 7,8 On the contrary, various studies have reported protective effect of misoprostol in allergic diseases. Babakhin et al has shown that misoprostol can inhibit basophil histamine release indicating a potentially beneficial role of PGE1 analogues as pharmacotherapy for allergic diseases.…”

A rare case of misoprostol hypersensitivity

“…[ 7 ] This rare adverse effect is not limited to pregnant women and a case of anaphylactic shock has also been reported following vaginal misoprostol administered for cervical ripening to a non-pregnant women posted for hysteroscopic myomectomy. [ 8 ]…”

Effect of Castor Oil on Cervical Ripening and Labor Induction: a systematic review and meta-analysis

“…In some cases, prostaglandins may not be used in pregnant women due to complications such as nausea and vomiting, fever and chills, blurred vision, diarrhea, and a bitter taste in the mouth [ 13 , 14 ]. Non-pharmacological methods for cervical ripening and labor induction include espand (steppenraute), dates, flaxweed, and chamomile.…”