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MISOPROSTOL-ONLY

RECOMMENDED REGIMENS 2017


www.figo.org

<13 weeks gestation 1326 weeks gestation >26 weeks gestation8 Postpartum use

Postpartum hemorrhage (PPH)


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