Sublingual Misoprostol-Induced Rhabdomyolysis and Convulsions in Postpartum Hemorrhage: A Case Report and Literature Review

TL;DR

A case report shows that sublingual misoprostol for postpartum hemorrhage can cause severe side effects like rhabdomyolysis and convulsions due to hyperpyrexia.

Contribution

Highlights a rare but severe adverse effect of sublingual misoprostol and suggests combining it with anti-pyretic measures to reduce risks.

Findings

Sublingual misoprostol can cause hyperpyrexia leading to convulsions and rhabdomyolysis.

Higher and faster plasma concentration via sublingual route increases risk of severe side effects.

Combining misoprostol with anti-pyretic management may reduce hyperthermia-related complications.

Abstract

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality, primarily attributed to uterine atony. Both the World Health Organization (WHO) and the International Federation of Gynecology and Obstetrics (FIGO) endorse the use of misoprostol not only for the prevention but also for the treatment of PPH. However, the administration of misoprostol is commonly associated with transient pyrexia, attributed to a shift in the hypothalamic set point observed in certain animal studies. Misoprostol-induced hyperpyrexia can occasionally manifest with a prodrome of shivering, particularly when administered via the sublingual route, which achieves a higher and faster maximum plasma concentration compared to vaginal and rectal routes. General management strategies to reduce fever involve removing clothing and blankets, applying cool compresses, administering oral acetaminophen, and ensuring adequate hydration. While some cases have reported misoprostol-induced convulsions, hyperpyrexia leading to convulsions and subsequent rhabdomyolysis is a rare and potentially lethal side effect.

In this case presentation, we emphasize a scenario where misoprostol was employed for the treatment of PPH but led to rhabdomyolysis. Our goal is to highlight the side effects of misoprostol and the significance of considering the initial combination of misoprostol with anti-pyretic management to minimize the risk of hyperthermia-related side effects and prevent additional severe complications.

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