Name of the Procedure:

Misoprostol, oral, 200 mcg (HCPCS Code: S0191)

Summary

Misoprostol is a medication taken orally as a tablet, commonly used to prevent stomach ulcers in patients taking NSAIDs (nonsteroidal anti-inflammatory drugs), induce labor, and treat postpartum bleeding due to its ability to cause uterine contractions.

Purpose

Misoprostol is used to:

• Prevent and treat stomach ulcers in patients on long-term NSAID therapy.
• Induce labor in pregnant women.
• Manage and treat postpartum hemorrhage.
• Facilitate medical abortion when combined with other medications.

The goal is to prevent ulcer formation, effectively manage labor induction, or control bleeding, thereby addressing specific medical conditions and improving patient outcomes.

Indications

• Patients who are at high risk of developing stomach ulcers due to NSAID use.
• Pregnant women requiring induction of labor for medical reasons.
• Women experiencing postpartum hemorrhage.
• Women seeking a medical abortion when used in combination with mifepristone or methotrexate.

Preparation

• For ulcer prevention: No special preparation required, but adherence to dosage instructions is crucial.
• For labor induction: The patient may need to be admitted to a hospital or clinic. Eating and drinking guidelines will follow medical advice.
• For postpartum hemorrhage: No preparation needed as it's an emergency intervention.
• For medical abortion: Specific instructions will be provided by the healthcare provider, including possibly fasting and taking other medications.

Procedure Description

1. For ulcer prevention, the patient takes the prescribed dose orally.
2. For labor induction, the woman is typically admitted to a hospital, given the oral dose, and monitored for signs of labor.
3. For postpartum hemorrhage, the medication is given orally or sublingually in a hospital setting to control bleeding.
4. For medical abortion, the medication is taken according to the provider's instructions, often following an initial dose of another drug like mifepristone.

Duration

The effects of the medication can start from within minutes to a few hours depending on its use (e.g., labor induction vs. ulcer prevention).

Setting

• Hospital or clinic for labor induction and postpartum hemorrhage.
• Outpatient or home setting for ulcer prevention.
• Clinic or approved healthcare setting for medical abortion.

Personnel

• Doctors
• Nurses
• Other healthcare providers depending on the setting and situation

Risks and Complications

• Common risks: Nausea, vomiting, diarrhea, abdominal pain, cramping.
• Rare risks: Heavy bleeding, allergic reactions, uterine rupture in labor induction (very rare but serious), incomplete abortion.

Benefits

• Effectively prevents NSAID-induced ulcers.
• Can safely induce labor under medical supervision.
• Controls postpartum bleeding, reducing maternal mortality risk.
• Alternative to surgical abortion with high efficacy.

Recovery

• For ulcer prevention: No recovery time needed, continue with prescribed regimen.
• For labor induction: Varies, usually involves a hospital stay until delivery.
• For postpartum hemorrhage: Immediate but may require hospital stay for monitoring.
• For medical abortion: Recovery can vary, follow-up visit typically required within 1-2 weeks.

Alternatives

• For ulcer prevention: Proton pump inhibitors or histamine-2 blockers.
• For labor induction: Mechanical methods like Foley catheter, or other medications like oxytocin.
• For postpartum hemorrhage: Surgical interventions (e.g., D&C or hysterectomy) if misoprostol is ineffective.
• For medical abortion: Surgical abortion (e.g., vacuum aspiration).

Patient Experience

• During the procedure: May experience side effects like abdominal cramps and nausea.
• Post-procedure: For labor induction, hospitalization with pain and cramps as typical labor progresses. For postpartum hemorrhage, monitored for bleeding and vitals. For medical abortion, expect bleeding and cramping similar to a heavy period.
• Pain management: Pain relief options include analgesics or epidurals for labor induction.

Pain and comfort measures will be provided as per the healthcare provider’s assessment and patient's needs.