Publication:

Acute convulsions following sublingual misoprostol administration for postpartum hemorrhage: a report of two cases

Misoprostol is widely used for the prevention and treatment of postpartum hemorrhage (PPH) because of its efficacy, affordability, and ease of administration. However, the sublingual route is associated with rapid absorption and higher peak plasma concentrations, which may increase the risk of systemic adverse effects. We report two cases of primigravida women who developed acute altered mental status, hallucinations, and generalized tonic–clonic seizures following administration of 800 µg sublingual misoprostol after vaginal delivery. Extensive evaluation excluded common obstetric and neurological causes of postpartum seizures. Both patients recovered completely with supportive management and anticonvulsant therapy. These cases highlight the possibility of severe neurotoxicity associated with high-dose sublingual misoprostol and emphasize the need for cautious use and careful monitoring in the postpartum period.