Misoprostol may be administered ora

Misoprostol may be administered orally as a lozenge
or vaginally in the posterior fornix. Dosing of
misoprostol is influenced by the size of the uterus and
several approaches have been published. If the uterus is
less than 28 weeks size, our approach is to place 200 mg
of misoprostol in the posterior fornix every 4 hours until
delivery of the fetus and placenta. The dose could be
increased to 400 mg every 2 hours, but delivery is not
hastened compared with 200 mg every 4 hours. The
oral dose (taken as a lozenge) is 200–400 mg every 2–4
hours. The interval to delivery is less when the drug is
administered vaginally compared with orally, but some
women may prefer to take the drug by mouth. If the
uterus is greater than 28 weeks size, we administer an
initial dose of 25 mg of misoprostol in the posterior
fornix, followed by 25–50 mg every 4 hours. Alternatively,
it may be given orally at a dosage of 25 mg every
4 hours. Prostaglandin E2 should not be used in women
with active cardiac, pulmonary or renal disease, and
glaucoma. All prostaglandins for medical induction of
labor should be avoided in cases of prior cesarean if
uterine size is greater than 26 weeks of gestation at the
time of induction. In such cases we use oxytocin (low