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This document provides recommended misoprostol-only regimens for various obstetric and gynecologic indications from less than 13 weeks gestation to postpartum use. It recommends dosages and administration routes depending on gestational age and indication. The regimens are based on evidence from clinical trials and guidelines from organizations like WHO and FIGO. Notes provide additional context for tailoring regimens based on individual circumstances and local resource availability.
This document provides recommended misoprostol-only regimens for various obstetric and gynecologic indications from less than 13 weeks gestation to postpartum use. It recommends dosages and administration routes depending on gestational age and indication. The regimens are based on evidence from clinical trials and guidelines from organizations like WHO and FIGO. Notes provide additional context for tailoring regimens based on individual circumstances and local resource availability.
This document provides recommended misoprostol-only regimens for various obstetric and gynecologic indications from less than 13 weeks gestation to postpartum use. It recommends dosages and administration routes depending on gestational age and indication. The regimens are based on evidence from clinical trials and guidelines from organizations like WHO and FIGO. Notes provide additional context for tailoring regimens based on individual circumstances and local resource availability.
Pregnancy termination a,b,1 Pregnancy termination 1,5,6 Pregnancy termination 1,5,9 prophylaxis i,2,10 800g sl every 3 hours 1324 weeks: 400g pv*/sl/bucc every 3 hoursa,e 2728 weeks: 200g pv*/sl/bucc every 4 hoursf,g 600g po (x1) or pv*/bucc every 312 hours (23 doses) 2526 weeks: 200g pv*/sl/bucc every 4 hours f >28 weeks: 100g pv*/sl/bucc every 6 hours or PPH secondary prevention j,11 (approx. 350ml blood loss) 800g sl (x1)
Fetal death 2,9
Missed abortion c,2 Fetal death f,g,1,5,6 2728 weeks: 100g pv*/sl/bucc every 4 hoursf PPH treatment k,2,10 800g pv* every 3 hours (x2) 200g pv*/sl/bucc every 46 hours >28 weeks: 25g pv* every 6 hours 800g sl (x1) or 600g sl every 3 hours (x2) or 25g po every 2 hoursh
Incomplete abortion a,2,3,4
Induction of labor h,2,9 600g po (x1) Inevitable abortion g,2,3,5,6,7 25g pv* every 6 hours or 400g sl (x1) 200g pv*/sl/bucc every 6 hours or 25g po every 2 hours or 400800g pv* (x1)
Cervical preparation for surgical abortion a
Cervical preparation for surgical abortion d 1319 weeks: 400g pv 34 hours before procedure 400g sl 1 hour before procedure >19 weeks: needs to be combined or pv* 3 hours before procedure with other modalities
References Notes Route of Administration
a WHO Clinical practice handbook for safe abortion, 2014 1 If mifepristone is available (preferable), follow the regimen prescribed for mifepristone + misoprostola pv vaginal administration b von Hertzen et al. Lancet, 2007; Sheldon et al. 2016 FIAPAC abstract 2 Included in the WHO Model List of Essential Medicines sl sublingual (under the tongue) c Gemzell-Danielsson et al. IJGO, 2007 3 For incomplete/inevitable abortion women should be treated based on their uterine size rather than last menstrual period (LMP) dating po oral d Sv et al. Human Reproduction, 2015; Kapp et al. Cochrane Database 4 Leave to take effect over 12 weeks unless excessive bleeding or infection bucc buccal (in the cheek) of Systematic Reviews, 2010 5 An additional dose can be offered if the placenta has not been expelled 30 minutes after fetal expulsion e Dabash et al. IJGO, 2015 6 Several studies limited dosing to 5 times; most women have complete expulsion before use of 5 doses, but other studies * Avoid pv (vaginal route) if bleeding f Perritt et al. Contraception, 2013 continued beyond 5 and achieved a higher total success rate with no safety issues and/or signs of infection g Mark et al. IJGO, 2015 7 Including ruptured membranes where delivery indicated h WHO recommendations for induction of labour, 2011 8 Follow local protocol if previous cesarean or transmural uterine scar Rectal route is not included as a i FIGO Guidelines: Prevention of PPH with misoprostol, 2012 9 If only 200g tablets are available, smaller doses can be made by dissolving in water (see www.misoprostol.org) recommended route because the j Raghavan et al. BJOG, 2015 10 Where oxytocin is not available or storage conditions are inadequate pharmacokinetic profile is not k FIGO Guidelines: Treatment of PPH with misoprostol, 2012 11 Option for community based programs associated with the best efficacy