Misoprostol is a synthetic prostaglandin E₁ analogue marketed as an oral preparation used to prevent and treat gastroduodenal damage induced by nonsteroidal anti-inflammatory drugs (NSAIDs). However, misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Misoprostol’s effects are dose dependent and include cervical softening and dilation, uterine contractions, nausea, vomiting, diarrhea, fever, and chills.¹ Although misoprostol is not approved by the US Food and Drug Administration (FDA) for these indications, in 2002, pregnancy was removed from the label as an absolute contraindication to misoprostol use.² Misoprostol’s advantages over other synthetic prostaglandin analogues are its low cost, long shelf life, lack of need for refrigeration, and worldwide availability (Figure 1).³