Can prostaglandins be used in an asthmatic patient?

Prostaglandins are frequently used for cervical ripening, labor induction, and postpartum hemorrhage. Their safety profile varies depending on prostaglandin subtype.

SAFE in asthma

• Prostaglandin E₁ (PGE₁): Misoprostol
• Limited data suggests Prostaglandin E₂ (PGE₂) is also safe and may be used when indicated: Dinoprostone

Both PGE₁ and PGE₂ have bronchodilatory properties and are considered safe for use in pregnant patients with asthma when clinically indicated.

Large prospective experience (Towers et al.) demonstrates no asthma exacerbations among 189 asthmatic patients receiving PGE₂ for induction.

NOT SAFE in asthma

• Prostaglandin F_2α (PGF₂α): Carboprost (Hemabate®)

PGF₂α is a potent bronchoconstrictor and may precipitate severe bronchospasm. ACOG, SMFM, obstetric anesthesia organizations, and GINA guidelines advise avoiding carboprost in asthma unless no alternatives exist.

Clinical Summary

• PGE₁ (misoprostol) — safe for induction or postpartum use
• PGE₂ (dinoprostone) — safe for induction and cervical ripening
• PGF₂α (carboprost) — avoid in asthma

All patients with asthma should be monitored closely with any uterotonic agent, but asthma itself is not a contraindication to misoprostol or dinoprostone.