Misoprostol In Obstetric Practice

Recommended FIGO dosages 2012

Osama M Warda MD
Professor of OB/GYN
Mansoura University
!  Cervical ripening before instrumentation: 400
microgram per vagina (PV) 3 hours or sublingual
( SL) 2-3 hours before procedure.*
!  Induced abortion: 800 microgram PV or SL 3
hourly ( maximum 3 doses per 12 hours).*
Only use where legal and with mifeprostole, where available.
*WHO/RHR. Safe abortion: technical and policy guidance for health
systems (2nd edition), 2012
!  Missed Abortion :
800 microgram PV 3 hourly (maximum 2 doses)
or
600 microgram SL 3 hourly ( maximum 2 doses).*

* Gemzell-Danielsson et al. IJGO, 2007

!  Incomplete abortion :
400 microgram SL or
600 microgram oral (PO) single dose. *
•  Included in the WHO Model list of Essential Medicines.
•  Leave to work for 1-2 weeks unless excessive bleeding or infection.

*WHO/RHR. Safe abortion: technical and policy guidance for health

systems (2nd edition), 2012
!  Induced abortion:
400 microgram PV or SL 3hourly
(maximum 5 doses).*
•  Only use where legal and with mifeprostole, where
available.
•  Half the dose if previous CS or uterine scar
*WHO/RHR. Safe abortion: technical and policy guidance for
health systems (2nd edition), 2012
!  Intrauterine fetal death 13-17 weeks: *
200 microgram PV 6 hourly (maximum 4 doses).[
!  Intrauterine fetal death 18-26 weeks:
100 microgram PV 6 hourly (maximum 4 doses).
-Half the dose if previous CS or uterine scar
* Gomez Ponce de Leon et al. IJGO,2007
! Intra-uterine fetal death :
25 microgram PV 6 hourly or 25
microgram PO 2 hourly.*
-  Make sure you use the correct dosage- overdose can
cause complications. Don’t use if previous cesarean
section.
*WHO recommendations for induction of labor, 2011
! Induction
of labor: 25 μg PV 6 hourly or
25μg PO 2 hourly. *
- Included in the WHO Model list of Essential Medicines.
-Make sure you use the correct dosage- overdose can cause
complications. Don’t use if previous cesarean section.

* WHO recommendations for induction of labor, 2011

!  PPH prophylaxis: 600 microgram PO single dose.*
-Included in the WHO Model list of Essential Medicines.
!  PPH treatment: 800 microgram SL single dose.**

* FIGO Guidelines: Prevention of PPH with misoprostol, 2012

** FIGO Guidelines: Treatment of PPH with misoprostol, 2012

1st trimester 2nd trimester 3rd trimester
Cervical ripening pre- Induced abortion : 400 IUFD: 25μg pv 6 hrly
instrumentation: 400μg pv μg pv or sl 3 hrly (max Or
3hrs, or sl 2-3 hrs before x5) 25μg po 2 hrly
procedure

Induced abortion: 800 μg pv IUFD 13-17 WKS: 200 Induction of labor:

or sl 3 hrly ( max x3 within μg pv 6 hrly (max x4) 25 μg pv 6 hrly
12hrs) Or
IUFD 18-26 wks: 25 μg po 2 hrly
100 μg pv 6 hrly (max x
Missed abortion: 800 μg pv 3 4) POST-PARTUM:
hrly (max x2) or - PPH prophylaxis: 600 μg
600 μg sl 3hrly (max x2) po sigle dose

- - PPH treatment: 800 μg

Incomplete abortion: 400 μg sl sigle dose
sl or 600 μg po single dose
Thank you