Microcrystalline Cellulose and Crospovidone Identified in Placentas With Vaginal Misoprostol Use

Am J Forensic Med Pathol. 2020 Sep;41(3):176-181. doi: 10.1097/PAF.0000000000000557.

Abstract

Misoprostol is a prostaglandin analog commonly used to induce termination of pregnancy. Clandestine home terminations complicate forensic fetal autopsy when a history of misoprostol use is withheld and the gross and histologic findings are sparse, as is often the case. One hundred thirty-two placentas with no vaginal misoprostol use, low-dose misoprostol use, and high-dose misoprostol use were reviewed for the presence, volume, and locations of microcrystalline cellulose and crospovidone, common tablet fillers in misoprostol tablets. Microcrystalline cellulose and/or crospovidone was identified in 0 (0%) of 88 cases with no vaginal administration or low-dose vaginal administration and 29 (66%) of 44 placentas with high-dose vaginal administration. When identified, microcrystalline cellulose and/or crospovidone is most commonly present on the maternal surfaces of the extraplacental membranes. The presence of microcrystalline cellulose and/or crospovidone was associated with smaller placental weight (Mann-Whitney U, P = 0.019). These fillers have a reasonable sensitivity for high-dose vaginal tablet use and are very specific. Although they are not diagnostic for misoprostol administration, they provide a finding that may prompt additional investigation into the nature of the vaginal tablet administered and the circumstances surrounding birth.

MeSH terms

  • Abortifacient Agents, Nonsteroidal / administration & dosage*
  • Administration, Intravaginal
  • Cellulose / analysis*
  • Excipients / analysis
  • Female
  • Forensic Pathology
  • Humans
  • Misoprostol / administration & dosage*
  • Organ Size
  • Placenta / chemistry*
  • Placenta / pathology
  • Povidone / analysis*
  • Pregnancy
  • Retrospective Studies

Substances

  • Abortifacient Agents, Nonsteroidal
  • Excipients
  • Misoprostol
  • Cellulose
  • Povidone
  • microcrystalline cellulose