Misoprostol Only Recommended Regime / Updated 2018
<13 weeks’ gestation
Pregnancy termination
800 μg sl every 3 hours
or
pv / bucc every 3–12 hours (2–3
doses)
Missed abortion / miscarriage
800 μg pv every 3 hours (x2)
or
600 μg sl every 3 hours (x2)
Incomplete abortion/ miscarriage
600 μg po (x1)
or
400 μg sl (x1)
or
400–800 μg pv (x1)
Cervical preparation for surgical
abortion/ miscarriage
400 μg sl 1 hour before procedure
or
pv 3 hours before procedure
13–26 weeks’ gestation
(An additional dose can be offered if the
placenta has not been expelled 30 minutes
after fetal expulsion)
Pregnancy termination
13–24 weeks: 400 μg pv /sl /bucc every 3
hours
25–26 weeks: 200 μg pv /sl/bucc every 4
hours
Fetal death
200 μg pv/sl/bucc every 4–6 hours
Inevitable abortion / Miscarriage
200 μg pv/sl /bucc every 6 hours
(Including ruptured membranes where
delivery indicated)
Cervical preparation for surgical
abortion/ miscarriage
13–19 weeks: 400 μg pv 3–4 hours before
procedure
>19 weeks: needs to be combined with
other modalities
>26 weeks’ gestation Postpartum use
Pregnancy termination Postpartum hemorrhage
(PPH) prophylaxis
27–28 weeks: 200 μg pv/sl/bucc every 4 hours 600 μg po (x1)
>28 weeks: 100 μg pv/sl/bucc every 6 hours or
(An additional dose can be offered if the PPH secondary prevention
placenta has not been expelled 30 minutes (approx. ≥350ml blood loss)
after fetal expulsion) 800μg sl (x1)
(For community based use)
Fetal death PPH treatment
27–28 weeks: 100μg pv/sl/bucc every 4 hours
800 μg sl (x1)
>28 weeks: 25μg pv every 6 hours
or 25μg po every 2 hours
( Reduce the dose for woman with previous
caesarean section)
Induction of labor
25μg pv every 6 hours
or
25μg po every 2 hours
(*Previous cesarean delivery or transmural
uterine incision is a contraindication
* Use in grandmaltiparous with caution
* Induction of labour should be carried out in
facilities where cesarean section can be
performed
* Close maternal & fetal monitoring are
needed)
 * Route of Administration: pv – vaginal administration, sl – sublingual (under the tongue), po – oral, bucc – buccal (in the cheek).
* Avoid pv (vaginal route) if bleeding and/or signs of infection.
* Rectal route is not included as a recommended route because the pharmacokinetic profile is not associated with the best efficacy.
Notes:
1- Use of misoprostol for termination of pregnancy need to be at hospital only, unless it is in the first trimester (in that case the woman
need to have no previous cesarean delivery, stable vitally and has an easy access to the hospital).
2- Pregnancy termination means termination for viable fetus and in accordance with the Iraqi MOH rules in this aspect.
3- For incomplete/inevitable miscarriage women should be treated based on their uterine size rather than last menstrual period (LMP)
dating.
4- For women with incomplete miscarriage leave to take effect over 1–2 weeks unless excessive bleeding or infection.
5- Several studies limited dosing to 5 times; for use between 13-26 weeks' gestation. Most women have complete expulsion before use
of 5 doses, but other studies continued beyond 5 and achieved a higher total success rate with no safety issues.
6- For postpartum use, only where oxytocin is not available or storage conditions are inadequate.
7- In case of previous caesarean or transmural uterine scare, the use need to be approved by a hospital committee.
8- If only 200 μg tablets are available, smaller doses for cases > 26 weeks' gestation can be made by dissolving in water (see
www.misoprostol.org/dilute-200-mcg-misoprostol-200ml-water).
9- For more information (see www.misoprostol.org).

References:
1- Misoprostol-only recommended regimens – FIGO 2017.
2- WHO Clinical practice handbook for safe abortion, 2014.
3- WHO recommendations for induction of labour, 2011.
4- Best practice in comprehensive abortion care. RCOG, June 2015.

Released: March, 27th, 2018 / Obs. & Gyn. consultative committee / MOH

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