Potentially acute misoprostol toxicity during third-trimester pregnancy: a case report

Background: The International Federation of Gynecology and Obstetrics (FIGO) recommends the dosage of misoprostol for pregnancy termination in >28 weeks is 25 mcg to 100 mcg per-vaginal or sublingual or buccal, every 6 hours, and the maximum dose is 6 mg. Acute misoprostol toxicity is rarely reported, including in the case of pregnant women. This study aims to discuss the effect of potentially acute misoprostol toxicity in pregnant women and the fetus.   Case Presentation: A 17 years-old woman, G1, 32 weeks, presented with singleton intrauterine fetal death. The patient previously consumed 14 tabs of oral misoprostol and 4 tabs of misoprostol intravaginally. Her vital signs were within a normal level, his 4x/10'/40", and her fetal heart rhythm was negative. From vaginal touché found complete dilation. The patient led to bear down and born baby boy, demise fetal, 1965-gram, 43 cm, no maceration and placenta born completely. After delivery, the mother was in good condition. Misoprostol is a synthetic analog of prostaglandin E1, which can be used for uterotonics and cervical ripening. In pregnant women, misoprostol toxicity can induce hypertonic uterine contractions, leading to fetal distress and death, rhabdomyolysis, hyperthermia, respiratory alkalosis, hypoxemia, and metabolic acidosis. One article reported maternal death due to upper gastrointestinal bleeding and multiorgan failure. We analyze that intrauterine fetal death may happen because of excessive misoprostol that induces hypertonic uterine contraction, causing fetal distress and leading to fetal demise. Conclusion: Excessive consumption of misoprostol or potentially acute misoprostol during the third-semester pregnancy can lead to harmful effects for both mother and fetus.