Gynuity Instructions for Use- Abortion induction with misoprostol

Publication date: 2004

ABORTION INDUCTION WITH BACKGROUND Misoprostol is a prostaglandin analog widel ulcers resulting from chronic administration induces uterine contractions, it is often use misoprostol can be used to terminate pregn trained medical professionals. INDICATION AND USAGE Effective regimens, their course, and succe information applies to pregnancies estimate pregnancy termination of gestations throug duration of the pregnancy, for example as e appropriate for the woman to use this meth CONTRAINDICATIONS – Confirmed or suspected ectopic pregnanc – IUD in place (remove IUD before adminis – History of allergy to misoprostol or other p PRECAUTIONS 1. TERATOGENIC EFFECTS IN LIVE BIRTHS FOLL According to animal model evidence, only o Sixty-nine cases of live births exhibiting ano of these case reports reveals that the majo nervous system and the upper and lower lim equinovarus (clubfoot), followed by anomal fingers. Three case-control studies conducted in hu anomalies among misoprostol-exposed infa appears low, on the order of 10 per 1000 e anomalies does not appear to be high, eve 2. NURSING MOTHERS Misoprostol is rapidly metabolized througho misoprostol) is excreted in human milk, alth milk. Discarding breast milk for 24 hours a occurrence of abdominal cramps or diarrhe 3. GESTATIONAL AGE BEYOND 9 COMPLETED W Caution is recommended when administeri insufficient evidence to recommend a regim described here is inappropriate beyond the gestation (see Notes). INSTRUCTIONS FOR USE MISOPROSTOL IN PREGNANCIES THROUGH 9 WEEKS LMP y marketed as Cytotec®. Cytotec® is registered for use to prevent gastric of nonsteroidal anti-inflammatory drugs (NSAIDs). As Cytotec® also d off-label for pregnancy termination. Studies have demonstrated that ancies of any gestation. This information is presented for the guidance of ss and complication rates depend on the length of gestation. The following d to be 9 completed weeks (63 days) LMP or less. Use of misoprostol for h 9 weeks LMP has a success rate of 85-90%. It is important to know the stimated by the last normal menstrual period, in order to determine if it is od. y or undiagnosed adnexal mass tering misoprostol) rostaglandin OWING FAILED ABORTION WITH MISOPROSTOL ne study involving rats has shown a teratogenic effect of misoprostol. malies after misoprostol exposure in utero have been reported. A review rity of the reported anomalies can be classified as pertaining to the central bs. The most frequent anomalies identified among all cases are ies of cranial nerves VII, VI, V, and XII, and agenesis (absence) of the man populations have consistently shown a higher prevalence of nts. However, the absolute risk of teratogenicity with misoprostol exposure xposed fetuses. In population-based registries, the observed incidence of n when misoprostol exposure is relatively frequent in the population. ut the body. It is not known if the active metabolite (misoprostol acid or ough almost all substances found in maternal serum are excreted in breast fter misoprostol administration may be prudent to avoid the potential a among breast fed infants. EEKS LMP ng misoprostol for abortions beyond 9 completed weeks LMP. There is en of misoprostol for late first trimester abortion induction. The regimen first trimester; the doses indicated here are too high for use later in EFFECTS AND SIDE EFFECTS Prolonged or serious effects and side effects are rare. 1. BLEEDING Bleeding often starts within the first day, generally within an hour after taking misoprostol. Bleeding typically lasts 7 to 10 days with additional days of spotting that can last until the next menstrual period. Return to menses usually occurs 4 to 6 weeks after misoprostol administration. It is important to understand that bleeding alone does not indicate a successful abortion. The woman should be instructed to contact the provider if any of the following occur: (1) if she soaks more than two maxi sanitary pads an hour for more than two consecutive hours, (2) if she stops bleeding and subsequently experiences a sudden onset of extremely heavy bleeding two weeks or longer after taking misoprostol, (3) if she has bled continuously for several weeks or begins to feel dizzy or light-headed, or (4) if no or scant bleeding has occurred by 7 days after misoprostol administration. 2. CRAMPING Cramping usually starts within the first day and may begin as early as 30 minutes after misoprostol administration. The pain may be much stronger than that experienced during a regular period. Nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesia can be used for pain relief without affecting success of the method. 3. CHILLS AND/OR FEVER Chills are common side effects of misoprostol but are transient. Fever is less common and does not necessarily indicate infection. If fever or chills persist beyond 24 hours after taking misoprostol, the woman may have an infection and should seek medical attention. An antipyretic can be used for relief of fever, if needed. 4. NAUSEA AND VOMITING Nausea and vomiting may occur and will resolve 2 to 6 hours after taking misoprostol. An antiemetic can be used if needed. 5. DIARRHEA Diarrhea may also occur following administration of misoprostol but should disappear within a day. DOSAGE AND ADMINISTRATION The recommended regimen for abortion induction with misoprostol in pregnancies through 9 weeks LMP is 800 mcg vaginal misoprostol, repeated after 24 hours (2 x 800 mcg). Evidence indicates that wetting the tablets with a few drops of water after vaginal insertion is likely to increase success with the method. Notes: • Misoprostol probably also works well when placed between the cheek and gum (buccally) or under the tongue (sublingually). • Currently, there is insufficient evidence to recommend a specific regimen of misoprostol for late first trimester induction. As gestation increases and the uterus becomes more sensitive to misoprostol, the dose necessary to effect expulsion will decrease. However, with increasing gestation, both the time required to expel the pregnancy and the expected blood loss will be increased. THIS DOCUMENT WILL BE PERIODICALLY REVIEWED AND UPDATED WITH CURRENT INFORMATION AND RESEARCH DEVELOPMENTS. © 2003 Gynuity Health Projects and Reproductive Health Technologies Project Revised: 8/31/2004 Suggested Citation: Consensus Statement: Instructions for Use – Abortion Induction with Misoprostol in Pregnancies through 9 Weeks LMP. Expert Meeting on Misoprostol sponsored by Reproductive Health Technologies Project and Gynuity Health Projects. July 28, 2003. Washington DC. For a reference list of literature supporting this document or for more information, refer to www.gynuity.org or www.rhtp.org. Background Indication and Usage Contraindications – Confirmed or suspected ectopic pregnancy or undiagnosed ad – IUD in place (remove IUD before administering misoprostol) – History of allergy to misoprostol or other prostaglandin Precautions 1. Teratogenic effects in live births following failed abort 2. Nursing mothers Effects and Side Effects Dosage and Administration

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