Gynuity Instuctions for use: Misoprostol for Treatment of Incomplete Abortion and Miscarriage

Publication date: 2004

A MISOPROSTOL FOR TRE BACKGROUND Misoprostol is a prostaglandin E1 analog ge from chronic administration of nonsteroidal contractions, it is commonly used off-label f abortions. Studies have demonstrated that information is presented for the guidance o INDICATION AND USAGE Misoprostol is indicated for treatment of inc equal to 12 weeks LMP at presentation. Use of misoprostol for incomplete abortion misoprostol for missed abortion has a succ CONTRAINDICATIONS 1. History of allergy to misoprostol or other 2. Suspicion of ectopic pregnancy 3. Signs of pelvic infection and/or sepsis 4. Symptoms of hemodynamic instability o PRECAUTIONS 1. Women eligible for misoprostol, but with 2. Caution is advised when treating women 3. Misoprostol may be used with caution in gestational age less than or equal to 12 we 4. Small amounts of misoprostol or its activ consequences of this and no adverse effec EFFECTS AND SIDE EFFECTS Prolonged or serious effects and side effec 1. BLEEDING After administration of misoprostol, bleedin last until the next menstrual period. The woman should be instructed to contact extra large sanitary pads an hour for more after bleeding has slowed or stopped for se feel dizzy or light-headed. INSTRUCTIONS FOR USE ATMENT OF INCOMPLETE ABORTION AND MISCARRIAGE nerally registered for prevention and treatment of gastric ulcers resulting anti-inflammatory drugs (NSAIDs). As misoprostol also induces uterine or treatment of early pregnancy failures including incomplete and missed misoprostol can be used effectively and safely for these indications. This f trained healthcare providers. omplete abortion and miscarriage for women with uterine size less than or has a success rate of 66 -100% using the recommended dose. Use of ess rate of 60-93% using the recommended dose. prostaglandin r shock an IUD in place, should have the IUD removed before drug administration. with known bleeding disorders or currently taking anti-coagulants. patients with uterine size larger than 12 weeks LMP but with a known eks (e.g. uterine enlargement due to fibroids). e metabolite may appear in breast milk. There are no known ts on nursing infants have been reported. ts are rare. g typically lasts up to two weeks with additional days of spotting that can a provider if any of the following occur: (1) if she soaks more than two than two consecutive hours, (2) if she suddenly experiences heavy bleeding veral days, (3) if she has bled continuously for several weeks and begins to 2. CRAMPING Cramping usually starts within the first few hours and may begin as early as 30 minutes after misoprostol administration. The pain may be stronger than that experienced during a regular period. Nonsteroidal anti- inflammatory drugs (NSAIDs) or other analgesia can be used for pain relief without affecting the success of the method. 3. FEVER AND/OR CHILLS Chills are a common side effect of misoprostol but are transient. Fever is less common and does not necessarily indicate infection. An antipyretic can be used for relief of fever, if needed. If fever or chills persist beyond 24 hours after taking misoprostol, the woman may have an infection and should seek medical attention. 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 resolve within a day. DOSAGE AND ADMINISTRATION Incomplete abortion: The recommended regimen for treatment of incomplete abortion with misoprostol is a single dose of 600 mcg misoprostol orally. Missed abortion: In the instance where diagnosis of missed abortion is certain and/or the cervix is firmly closed, the recommended regimen is a single dose of 800 mcg misoprostol vaginally. Highest success rates are achieved with extended follow-up (7 to 14 days) to allow completion of expulsion. Surgical intervention is not recommended prior to 7 days after treatment unless medically necessary. Notes: • There is also evidence that a repeated dose may increase efficacy. • Misoprostol probably also works well when placed between the cheek and gum (buccally) or under the tongue (sublingually). Suggested Citation: Consensus Statement: Instructions for Use – Misoprostol for Treatment of Incomplete Abortion and Miscarriage. Expert Meeting on Misoprostol sponsored by Reproductive Health Technologies Project and Gynuity Health Projects. June 9, 2004. New York, NY. For a reference list of literature supporting this document or for more information, refer to www.gynuity.org or www.rhtp.org. THIS DOCUMENT WILL BE PERIODICALLY REVIEWED AND UPDATED WITH CURRENT INFORMATION AND RESEARCH DEVELOPMENTS. © 2004 Gynuity Health Projects and Reproductive Health Technologies Project 11/23/04 Background Indication and Usage Contraindications 1. History of allergy to misoprostol or other prostaglandin Precautions 1. Women eligible for misoprostol, but with an IUD in place 2. Caution is advised when treating women with known bleedi 3. Misoprostol may be used with caution in patients with ut 4. Small amounts of misoprostol or its active metabolite ma Effects and Side Effects Dosage and Administration

View the publication