妊娠晚期米索前列醇促宫颈成熟给药途径探讨

Study on Administration Routes of Misoprostol for Promoting Cervical Ripening in the Third Trimester of Pregnancy

目的探讨妊娠晚期米索前列醇促宫颈成熟不同给药途径的优缺点。方法查阅国内外相关文献与行业指南,通过对阴道给药、舌下给药、口服给药3种给药途径的药代动力学、给药剂量与安全性进行比较,阐述米索前列醇用于妊娠晚期促宫颈成熟3种给药途径的优劣。结果阴道给药与舌下给药各具优势;阴道给药生物利用度高,药效延长,但起效稍慢;舌下给药由于达峰迅速,峰浓度更高,可能会引起更多的不良事件发生。结论米索前列醇用于妊娠晚期促宫颈成熟属超说明书用药,在选择米索前列醇用于促宫颈成熟时,应权衡利弊,保证孕妇和胎儿的安全。

Objective To investigate the advantages and disadvantages of different administration routes of misoprostol for promoting cervical ripening in the third trimester of pregnancy. Methods The pharmacokinetics,dose and safety of three routes of administration,such as vaginal administration,sublingual administration and oral administration were compared by referring to the domestic and international literatures and guidelines of clinical research. The advantages and disadvantages of three routes of administration of misoprostol for promoting cervical ripening in the third trimester of pregnancy were described. Results Vaginal and sublingual administration had their own advantages. Vaginal administration had the advantages of high bioavailability,prolonged efficacy,but slower onset of action. Sublingual administration could reach peak concentration rapidly, and peak concentrations were higher than other routes of administration, but it could induce more adverse events. Conclusion Misoprostol used for promoting cervical ripening in the third trimester of pregnancy belongs to off-label drug use. Misoprostol is selected for cervical ripening, the advantages and disadvantages should be evaluated to ensure the safety of pregnant women and fetuses.