Gynuity Health Projects

Gynuity Health Projects (GHP) is working to address operational and service delivery issues related to widely introducing misoprostol into health systems, particularly at the community and district levels. GHP also aims to influence international policies, technical guidance, and clinical practice to ensure that they reflect new evidence. An important aspect of this work involves gathering stakeholders to discuss issues related to product availability.

To this end, Gynuity Health Projects convened a meeting to clarify pathways for moving forward in accordance with scientific evidence to foster availability of misoprostol and its use for postpartum hemorrhage indications. This included discussion of what registration means, how it can be optimally pursued, where registration fits in the context of making misoprostol available to meet women’s and health systems needs, and how and when it might make sense to proceed without product registration.

More than 50 participants from around the world gathered in New York City on March 24-25, 2011 to discuss “The Product Problem: Pathways for Making Misoprostol Available for Post-Partum Hemorrhage”. Each day included a number of speakers as well as moderated discussions.

Gynuity Health Projects (GHP) is working to address operational and service delivery issues related to widely introducing misoprostol into health systems, particularly at the community and district levels. GHP also aims to influence international policies, technical guidance, and clinical practice to ensure that they reflect new evidence. An important aspect of this work involves gathering stakeholders to discuss issues related to product availability.

To this end, Gynuity Health Projects convened a meeting to clarify pathways for moving forward in accordance with scientific evidence to foster availability of misoprostol and its use for postpartum hemorrhage indications. This included discussion of what registration means, how it can be optimally pursued, where registration fits in the context of making misoprostol available to meet women’s and health systems needs, and how and when it might make sense to proceed without product registration.

More than 50 participants from around the world gathered in New York City on March 24-25, 2011 to discuss “The Product Problem: Pathways for Making Misoprostol Available for Post-Partum Hemorrhage”. Each day included a number of speakers as well as moderated discussions.

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

This study evaluated the clinical benefit of pretreatment with mifepristone followed by misoprostol compared with misoprostol alone for second-trimester abortion. The results confirmed that the combined regimen is more efficacious and faster than misoprostol alone. Read the full abstract at Obstetrics and Gynecology (Sep 2011);118(3):601-8.

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

This review article evaluates existing reports of acceptance and satisfaction with medical abortion regimens, the key determinants of satisfaction and explores their impact on women’s perceptions of their medical abortion experiences. Read the abstract at Expert Rev. Obstet. Gynecol (Jul 2011);6(4):451–468.

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

This reference list forms the basis for the regimen outlined in the brochure Instructions for Use (IFU): Misoprostol for Treatment of Postpartum Hemorrhage

This reference list forms the basis for the regimen outlined in the brochure Instructions for Use (IFU): Misoprostol for Treatment of Postpartum Hemorrhage

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

The fourth in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for treatment of postpartum hemorrhage was drafted based on current available information. Gynuity consulted professionals with epidemiological, clinical and programmatic expertise on PPH treatment and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

This article reports on the outcomes of a trial designed to evaluate a misoprostol-alone regimen to a combined regimen of mifepristone-misoprostol for early abortion. The results found that the combined regimen was significantly more effective than the misoprostol-alone regimen studied for early medical abortion. Read the full abstract at Contraception (May 2011), Vol. 83(5):410-417.

This editorial explores issues of safety and effectiveness of medical abortion among adolescents compared to adults, reflecting on an article by Niinimäki 2011. No evidence suggests that medical abortion is more risky or less successful in adolescents than in older women. Read an excerpt at BMJ 2011;342:d2185.

The article examines the commercial, political, regulatory, and legislative history of the introduction of mifepristone-misoprostol in France and the United States. Read the full abstract at Contraception (Apr 2011), Vol. 83(4):322-29.

The aim of this review was to determine the effectiveness and safety of repeated precoital and postcoital use of levonorgestrel for pregnancy prevention. The data suggested that pericoital oral levonorgestrel is safe and moderately effective. However, a pressing need exists for rigorous research to evaluate pericoital use of levonorgestrel as a primary means of contraception. Read the full abstract at Obstetrics and Gynecology (Mar 2011) Vol. 117(3):673-81.

The goal of the study was to evaluate a new gel and procedure for non-surgical sterilization. This study did not identify a gel and insertion procedure that would reliably provide exposure of both fallopian tubes to a sclerosing agent for more than a brief period of time. Read the full abstract at Contraception (March 2011) Vol. 83(3):263-267.

This review article aims to determine the effectiveness and safety of repeated precoital and postcoital use of levonorgestrel for pregnancy prevention. The data suggested that pericoital oral levonorgestrel is safe and moderately effective. However, the quality of the studies was suboptimal. A pressing need exists for rigorous research to evaluate pericoital use of levonorgestrel as a primary means of contraception. Read the full abstract at Obstetrics & Gynecology (March 2011). Vol. 117(3):673-681.

This article reports on the results of a study designed to evaluate the use of misoprostol as an adjunct to standard uterotonic therapy for active management of the third stage of labor. Read the full abstract at Int J Gynecol Obstet (Feb 2011), Vol 112(2):98-102. doi:10.1016/j.ijgo.2010.08.019

This article reports on the outcomes of a study testing the feasibility and efficacy of an approach that foregoes the routine use of ultrasound for the determination of eligibility for medical termination of pregnancy. The results show that women’s assessment of the date of their last menstrual period and physical examination alone are highly effective for the determination of women’s eligibility for early abortion with mifepristone–misoprostol. Read the full abstract at BJOG (Jan 2011), Vol. 118(1):17-23.

This article reports on a study conducted in rural Pakistan to determine if misoprostol is safe and efficacious in preventing postpartum haemorrhage when administered by trained traditional birth attendants at home deliveries. Read the full abstract at BJOG (Jan 2011), Article first published online: 23 DEC 2010 DOI: 10.1111/j.1471-0528.2010.02807.x

This article reports on a study comparing 600 mcg oral misoprostol as an alternative to manual vacuum aspiration (MVA) for the treatment of incomplete abortion. This study confirms results of similar studies using the same protocol showing that 600 mcg oral misoprostol is a highly effective and safe method for this indication. Read the full abstract at International Journal of Gynecology & Obstetrics (Jan 2011), Vol.

This article reports on two oral routes of misoprostol followed by mifepristone for early medical abortion. The results show that a 400 mcg dose of misoprostol delivered sublingually or buccally are equally effective. Read the full abstract at Contraception, 82(6):513–519.

This article reports on a qualitative study of women in four U.S. cities who attempted to self-induce abortion, the methods used and their motivations for the attempt. Read the full abstract at Reproductive Health Matters, 18(36):136-146.

This information sheet, designed for women’s health advocates in collaboration with the International Women’s Health Coalition, offers information about the use of misoprostol regimens for pregnancy termination. The resource offers basic information on dosing options, primary and secondary effects, and how to obtain misoprostol. The resource is available in four languages.

This information sheet, designed for women’s health advocates in collaboration with the International Women’s Health Coalition, offers information about the use of misoprostol regimens for pregnancy termination. The resource offers basic information on dosing options, primary and secondary effects, and how to obtain misoprostol. The resource is available in four languages.

This information sheet, designed for women’s health advocates in collaboration with the International Women’s Health Coalition, offers information about the use of misoprostol regimens for pregnancy termination. The resource offers basic information on dosing options, primary and secondary effects, and how to obtain misoprostol. The resource is available in four languages.

This information sheet, designed for women’s health advocates in collaboration with the International Women’s Health Coalition, offers information about the use of misoprostol regimens for pregnancy termination. The resource offers basic information on dosing options, primary and secondary effects, and how to obtain misoprostol. The resource is available in four languages.

This article reports on a study designed to test the feasibility and efficacy of an approach that foregoes the routine use of ultrasound for the determination of eligibility for medical termination of pregnancy. The results indicate that LMP and physical examination alone, without the routine use of ultrasound, are highly effective for the determination of women’s eligibility for early termination of pregnancy with mifepristone–misoprostol. Read the full abstract at BJOG 2011;118:17–23.

This information sheet, designed for women’s health advocates in collaboration with the International Women’s Health Coalition, offers information about the use of misoprostol regimens for pregnancy termination. The resource offers basic information on dosing options, primary and secondary effects, and how to obtain misoprostol. The resource is available in four languages.

This article reports on the results of a study comparing sublingual misoprostol to MVA for the treatment of incomplete abortion in Egypt. The results demonstrate that misoprostol is a highly effective and feasible treatment alternative to surgery, and that the likelihood of a clinically important drop in Hb (<2 g/dl) post treatment is comparably rare following medical and surgical treatment. The abstract of this article can be found at the following link: International Journal of Gynaecology and Obstetetrics (Nov 2010); Vol. 111, Issue 2, Pages 131-135).

This tool was developed for health care providers and policy makers who are interested in introduction of medical methods for safe termination of early pregnancy. It describes evidence-based regimens and practical considerations for introducing the method as part of abortion care, especially as related to low-resource settings.

The availability and use of medical abortion has increased rapidly since the publication of the first edition of this guidebook in 2004. We wrote the second edition of Providing Medical Abortion in Developing Countries: An Introductory Guidebook to incorporate important scientific developments and innovations in clinical practice. These changes have informed the emergence of protocols that can be used in a variety of low-resource settings worldwide. The new title Providing Medical Abortion in Low-Resource Settings reflects these broader applications. The guidebook follows the same chapter and topic sequence as the first edition. The second edition includes updated information on routes of misoprostol administration, infection and medical abortion, use of medical abortion for late first trimester abortion induction, telemedicine and medical abortion, professional and international clinical guidelines for use of mifepristone-misoprostol medical abortion, and a list of additional resources now available.

Please note that the Arabic, English, French, Portuguese, Russian, Spanish, Turkish, and Tamil language versions of the 2nd edition are available for download. The first edition of this resource is still available in Romanian and Vietnamese from the drop-down menu.

Gynuity Health Projects and Reproductive Health Technologies Project convened an expert meeting looking at the use of misoprostol for incomplete abortion and miscarriage in 2004. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of misoprostol based on the best current information. The results can be found in a brochure called “Instructions for Use – (IFU).” The information in this document may serve as a basis for the development of clinical practice guidelines and patient and provider education materials. The brochure was updated in June, 2008 based on new information and research developments.

This article offers a secondary analysis from a medical abortion study conducted in the U.S. in different clinical settings. The results demonstrate that medical abortion has similar efficacy and patient satisfaction when offered in a family medicine practice or at a reproductive health specialty clinic. Read the full abstract at Journal of the American Board of Family Medicine, 2010, Vol 23(4):509-13.

This article describes the results of a clinical trial seeking to evaluate the use of misoprostol compared to standard oxytocics for treatment of postpartum hemorrhage in women receiving prophylactic oxytocin during labor. The results demonstrate that misoprostol is clinically equivalent to oxytocin when used to stop excessive post-partum bleeding suspected to be due to uterine atony under these circumstances. Read the abstract at The Lancet (Jan 2010), Vol 375(9710), pp 217 – 223.

This article describes the results of a clinical trial seeking to evaluate the use of misoprostol compared to standard oxytocics for treatment of postpartum hemorrhage in women who were not previously exposed to oxytocin during labor. The results demonstrate that misoprostol may be a suitable first-line treatment alternative for this indication particularly in settings in which use of oxytocin is not feasible. Read the abstract at The Lancet (Jan 2010), Vol 375(9710), pp 210 – 216.

This article reports on a study evaluating misoprostol used in conjunction with routine injectable uterotonics for treatment of postpartum hemorrhage. The findings do not support clinical use of 600mcg sublingual misoprostol in addition to standard injectable uterotonics for treatment of postpartum hemorrhage. Read the full abstract at The Lancet, Vol 375(9728):1808-1813.

This book chapter, published in Maternal and Infant Deaths – Chasing Millennium Goals 4 and 5, Kehoe, JP Neilson, and JE Norman (eds.) RCOG Press, London 2010, Chapter 9, pp. 149-161, describes the problem of and pathways to unsafe abortion and strategies to reduce its impact. The chapter is available for download and is hosted by kind permission of the Royal College of Obstetricians and Gynaecologists. The book can be purchased at the RCOG website at the following link.

This book chapter, published in Maternal and Infant Deaths – Chasing Millennium Goals 4 and 5, Kehoe, JP Neilson, and JE Norman (eds.) RCOG Press, London 2010, Chapter 9, pp. 149-161, describes the problem of and pathways to unsafe abortion and strategies to reduce its impact. The chapter is available for download and is hosted by kind permission of the Royal College of Obstetricians and Gynaecologists. The book can be purchased at the RCOG website at the following link.

This tool was developed for health care providers and policy makers who are interested in introduction of medical methods for safe termination of early pregnancy. It describes evidence-based regimens and practical considerations for introducing the method as part of abortion care, especially as related to low-resource settings.

The availability and use of medical abortion has increased rapidly since the publication of the first edition of this guidebook in 2004. We wrote the second edition of Providing Medical Abortion in Developing Countries: An Introductory Guidebook to incorporate important scientific developments and innovations in clinical practice. These changes have informed the emergence of protocols that can be used in a variety of low-resource settings worldwide. The new title Providing Medical Abortion in Low-Resource Settings reflects these broader applications. The guidebook follows the same chapter and topic sequence as the first edition. The second edition includes updated information on routes of misoprostol administration, infection and medical abortion, use of medical abortion for late first trimester abortion induction, telemedicine and medical abortion, professional and international clinical guidelines for use of mifepristone-misoprostol medical abortion, and a list of additional resources now available.

Please note that the Arabic, English, French, Portuguese, Russian, Spanish, Turkish, and Tamil language versions of the 2nd edition are available for download. The first edition of this resource is still available in Romanian and Vietnamese from the drop-down menu.

Gynuity is pleased to announce the publication of our new resource for clinicians and women’s health advocates: Misoprostol for Treatment of Incomplete Abortion: An Introductory Guidebook. Misoprostol has many advantages in low-resource settings – it is inexpensive, widely available, thermostable, and offers a low-tech, non-invasive method of uterine evacuation. Based on current scientific evidence, the guidebook offers detailed information about misoprostol for this indication including:

• Efficacy, safety and acceptability;
• Eligibility criteria and precautions;
• Dosing, timing and routes of administration;
• Visit schedule and management of complications;
• Counseling and information provision;
• Integration of misoprostol into existing PAC services.

In April, 2009, the World Health Organization announced the addition of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The recommendation was made by an expert committee that evaluated available evidence, including numerous randomized comparative clinical trials and several guidelines developed by professional associations for this indication.

This list describes clinical research conducted by Gynuity Health Projects in collaboration with local colleagues. It also notes the specific countries in which each protocol has been or is currently being implemented.

This summary describes Gynuity’s work in the area of STIs, HIV and infectious disease.

This summary describes Gynuity’s body of work in the area of pre-eclampsia.

This summary describes Gynuity’s body of work in the area of postpartum hemorrhage prevention and treatment. Please note, at this time the English version was recently updated to reflect new program activities, additional language translations are forthcoming.

This summary describes Gynuity’s body of work in the area of pregnancy failure and miscarriage.

This summary describes Gynuity’s body of work in the area of medical abortion.

This summary describes Gynuity’s efforts in training and education to a range of audiences on issues related to reproductive and maternal health.

This summary describes Gynuity’s work in the area of policy and advocacy related to a range of reproductive and maternal health issues in the U.S. and internationally.

This summary describes Gynuity’s activites related to materials development.

This summary describes Gynuity’s work in the area of social science research on a range of reproductive and maternal health issues.

This summary describes Gynuity’s efforts to provide technical assistance on a range of reproductive and maternal health issues to national and international organizations.

Gynuity, in collaboration with Ipas, organized and co-sponsored the third international conference of the International Consortium of Medical Abortion held in Lisbon, Portugal. The conference drew over 150 women’s health advocates, clinical provider and policymakers dedicated to increasing access to medical abortion worldwide.

In recent years, relentless efforts to restrict abortion rights have intersected with an emerging movement to compromise the rights of pregnant women. The well-publicized prosecutions of several women who used misoprostol to self-induce an abortion highlight this intersection. The criminalization of women’s behavior during pregnancy demands a nuanced response from the reproductive justice community, one that differs from responses mobilized to advance abortion access. In particular, responses to the criminalization of abortion self-induction must acknowledge the complex factors that lead women to choose self-induction rather than to seek abortion services from a medical provider.

In August 2009, Gynuity Health Projects and the Reproductive Health Technologies Project convened a meeting of medical providers, lawyers, women’s health advocates, researchers and policymakers to discuss lessons learned in two prosecution cases of women who had used misoprostol without the involvement of medical practitioners. This report presents the major highlights from the meeting and subsequent recommendations for working with the media, the legal and medical communities, and with the reproductive health, rights, and justice communities.

This article reports on a study evaluating misoprostol used in conjunction with routine injectable uterotonics for treatment of postpartum hemorrhage. The findings do not support clinical use of 600mcg sublingual misoprostol in addition to standard injectable uterotonics for treatment of postpartum hemorrhage. Read the full abstract at The Lancet, Vol 375(9728):1808-1813.

This tool was developed for health care providers and policy makers who are interested in introduction of medical methods for safe termination of early pregnancy. It describes evidence-based regimens and practical considerations for introducing the method as part of abortion care, especially as related to low-resource settings.

The availability and use of medical abortion has increased rapidly since the publication of the first edition of this guidebook in 2004. We wrote the second edition of Providing Medical Abortion in Developing Countries: An Introductory Guidebook to incorporate important scientific developments and innovations in clinical practice. These changes have informed the emergence of protocols that can be used in a variety of low-resource settings worldwide. The new title Providing Medical Abortion in Low-Resource Settings reflects these broader applications. The guidebook follows the same chapter and topic sequence as the first edition. The second edition includes updated information on routes of misoprostol administration, infection and medical abortion, use of medical abortion for late first trimester abortion induction, telemedicine and medical abortion, professional and international clinical guidelines for use of mifepristone-misoprostol medical abortion, and a list of additional resources now available.

Please note that the Arabic, English, French, Portuguese, Russian, Spanish, Turkish, and Tamil language versions of the 2nd edition are available for download. The first edition of this resource is still available in Romanian and Vietnamese from the drop-down menu.

This article describes the results of a systematic review of measured postpartum blood loss with and without prophylactic uterotonics for prevention of postpartum haemorrhage. Access the full text at the following link BJOG 2010;117:788–800.

Through a post-hoc analysis, this paper evaluates factors leading to an elevated body temperature in some women given misoprostol for treatment of postpartum haemorrhage. Access the full text at the following link BJOG 2010;117:845–852.

This list describes clinical research conducted by Gynuity Health Projects in collaboration with local colleagues. It also notes the specific countries in which each protocol has been or is currently being implemented.

Gynuity, in collaboration with Ipas, organized and co-sponsored the third international conference of the International Consortium of Medical Abortion held in Lisbon, Portugal. The conference drew over 150 women’s health advocates, clinical provider and policymakers dedicated to increasing access to medical abortion worldwide.

This article reports on a study designed to evaluate the efficacy and acceptability of home administration of misoprostol for early medical abortion in Indian family planning clinics. Home administration of misoprostol was found to be safe and feasible for introduction into medical abortion services in India. Access the full abstract at International Journal of Gynaecology and Obstetrics, (Mar 2010). 108(3): 228–232.

This article reports on a study that evaluated the ability of women and their providers to assess abortion outcome without the routine use of ultrasonography. The results demonstrate that women and providers can accurately assess whether follow-up care is required after medical abortion without routine ultrasonography by reliance on women’s observations, a low-sensitivity pregnancy test, and clinical examination.

Access the full abstract of this article at Obstetrics and Gynecology (Feb 2010), V115, pp:264-272.

This article describes the results of a clinical trial seeking to evaluate the use of misoprostol compared to standard oxytocics for treatment of postpartum hemorrhage in women receiving prophylactic oxytocin during labor. The results demonstrate that misoprostol is clinically equivalent to oxytocin when used to stop excessive post-partum bleeding suspected to be due to uterine atony under these circumstances. Read the abstract at The Lancet (Jan 2010), Vol 375(9710), pp 217 – 223.

This article describes the results of a clinical trial seeking to evaluate the use of misoprostol compared to standard oxytocics for treatment of postpartum hemorrhage in women who were not previously exposed to oxytocin during labor. The results demonstrate that misoprostol may be a suitable first-line treatment alternative for this indication particularly in settings in which use of oxytocin is not feasible. Read the abstract at The Lancet (Jan 2010), Vol 375(9710), pp 210 – 216.

Gynuity is pleased to announce the publication of our new resource for clinicians and women’s health advocates: Misoprostol for Treatment of Incomplete Abortion: An Introductory Guidebook. Misoprostol has many advantages in low-resource settings – it is inexpensive, widely available, thermostable, and offers a low-tech, non-invasive method of uterine evacuation. Based on current scientific evidence, the guidebook offers detailed information about misoprostol for this indication including:

• Efficacy, safety and acceptability;
• Eligibility criteria and precautions;
• Dosing, timing and routes of administration;
• Visit schedule and management of complications;
• Counseling and information provision;
• Integration of misoprostol into existing PAC services.

In April, 2009, the World Health Organization announced the addition of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The recommendation was made by an expert committee that evaluated available evidence, including numerous randomized comparative clinical trials and several guidelines developed by professional associations for this indication.

Gynuity is pleased to announce the publication of our new resource for clinicians and women’s health advocates: Misoprostol for Treatment of Incomplete Abortion: An Introductory Guidebook. Misoprostol has many advantages in low-resource settings – it is inexpensive, widely available, thermostable, and offers a low-tech, non-invasive method of uterine evacuation. Based on current scientific evidence, the guidebook offers detailed information about misoprostol for this indication including:

• Efficacy, safety and acceptability;
• Eligibility criteria and precautions;
• Dosing, timing and routes of administration;
• Visit schedule and management of complications;
• Counseling and information provision;
• Integration of misoprostol into existing PAC services.

In April, 2009, the World Health Organization announced the addition of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The recommendation was made by an expert committee that evaluated available evidence, including numerous randomized comparative clinical trials and several guidelines developed by professional associations for this indication.

Gynuity is pleased to announce the publication of our new resource for clinicians and women’s health advocates: Misoprostol for Treatment of Incomplete Abortion: An Introductory Guidebook. Misoprostol has many advantages in low-resource settings – it is inexpensive, widely available, thermostable, and offers a low-tech, non-invasive method of uterine evacuation. Based on current scientific evidence, the guidebook offers detailed information about misoprostol for this indication including:

• Efficacy, safety and acceptability;
• Eligibility criteria and precautions;
• Dosing, timing and routes of administration;
• Visit schedule and management of complications;
• Counseling and information provision;
• Integration of misoprostol into existing PAC services.

In April, 2009, the World Health Organization announced the addition of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The recommendation was made by an expert committee that evaluated available evidence, including numerous randomized comparative clinical trials and several guidelines developed by professional associations for this indication.

This annotated bibliography provides basic information about the studies that were used to create the regimen outlined in the brochure Instructions for Use: Abortion Induction with Misoprostol in Pregnancies up to 9 Weeks LMP. It was updated in July, 2008, to include additional relevant publications.

This tool was developed for health care providers and policy makers who are interested in introduction of medical methods for safe termination of early pregnancy. It describes evidence-based regimens and practical considerations for introducing the method as part of abortion care, especially as related to low-resource settings.

The availability and use of medical abortion has increased rapidly since the publication of the first edition of this guidebook in 2004. We wrote the second edition of Providing Medical Abortion in Developing Countries: An Introductory Guidebook to incorporate important scientific developments and innovations in clinical practice. These changes have informed the emergence of protocols that can be used in a variety of low-resource settings worldwide. The new title Providing Medical Abortion in Low-Resource Settings reflects these broader applications. The guidebook follows the same chapter and topic sequence as the first edition. The second edition includes updated information on routes of misoprostol administration, infection and medical abortion, use of medical abortion for late first trimester abortion induction, telemedicine and medical abortion, professional and international clinical guidelines for use of mifepristone-misoprostol medical abortion, and a list of additional resources now available.

Please note that the Arabic, English, French, Portuguese, Russian, Spanish, Turkish, and Tamil language versions of the 2nd edition are available for download. The first edition of this resource is still available in Romanian and Vietnamese from the drop-down menu.

This document summarizes select articles on different aspects of mifepristone medical abortion provision such as efficacy, safety, and acceptability of regimens used for first and second trimester pregnancies.

This document summarizes select articles on different aspects of mifepristone medical abortion provision such as efficacy, safety, and acceptability of regimens used for first and second trimester pregnancies.

This document summarizes select articles on different aspects of mifepristone medical abortion provision such as efficacy, safety, and acceptability of regimens used for first and second trimester pregnancies.

Gynuity is pleased to announce the publication of our new resource for clinicians and women’s health advocates: Misoprostol for Treatment of Incomplete Abortion: An Introductory Guidebook. Misoprostol has many advantages in low-resource settings – it is inexpensive, widely available, thermostable, and offers a low-tech, non-invasive method of uterine evacuation. Based on current scientific evidence, the guidebook offers detailed information about misoprostol for this indication including:

• Efficacy, safety and acceptability;
• Eligibility criteria and precautions;
• Dosing, timing and routes of administration;
• Visit schedule and management of complications;
• Counseling and information provision;
• Integration of misoprostol into existing PAC services.

In April, 2009, the World Health Organization announced the addition of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The recommendation was made by an expert committee that evaluated available evidence, including numerous randomized comparative clinical trials and several guidelines developed by professional associations for this indication.

Gynuity is pleased to announce the publication of our new resource for clinicians and women’s health advocates: Misoprostol for Treatment of Incomplete Abortion: An Introductory Guidebook. Misoprostol has many advantages in low-resource settings – it is inexpensive, widely available, thermostable, and offers a low-tech, non-invasive method of uterine evacuation. Based on current scientific evidence, the guidebook offers detailed information about misoprostol for this indication including:

• Efficacy, safety and acceptability;
• Eligibility criteria and precautions;
• Dosing, timing and routes of administration;
• Visit schedule and management of complications;
• Counseling and information provision;
• Integration of misoprostol into existing PAC services.

In April, 2009, the World Health Organization announced the addition of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The recommendation was made by an expert committee that evaluated available evidence, including numerous randomized comparative clinical trials and several guidelines developed by professional associations for this indication.

This research summary describes the results of a series of clinical trials conducted by Gynuity and international colleagues on the use of misoprostol for the treatment of postpartum hemorrhage. The findings show:

• Sublingual misoprostol (800 mcg) is a safe, effective and acceptable alternative first-line treatment for PPH due to uterine atony.
• Misoprostol is easy to administer and may be particularly useful in settings where administration of IV oxytocin is not possible, particularly at lower levels of the health care system.
• Simultaneous administration of misoprostol (600 mcg) to conventional uterotonics for PPH treatment confers no clinical advantage.

Results of two of the trials described in this summary were published in The Lancet, Volume 375, Issue 9710, Pages 210 – 216, and Volume 375, Issue 9710, Pages 217 – 223.

This research summary describes the results of a series of clinical trials conducted by Gynuity and international colleagues on the use of misoprostol for the treatment of postpartum hemorrhage. The findings show:

• Sublingual misoprostol (800 mcg) is a safe, effective and acceptable alternative first-line treatment for PPH due to uterine atony.
• Misoprostol is easy to administer and may be particularly useful in settings where administration of IV oxytocin is not possible, particularly at lower levels of the health care system.
• Simultaneous administration of misoprostol (600 mcg) to conventional uterotonics for PPH treatment confers no clinical advantage.

Results of two of the trials described in this summary were published in The Lancet, Volume 375, Issue 9710, Pages 210 – 216, and Volume 375, Issue 9710, Pages 217 – 223.

This research summary describes the results of a series of clinical trials conducted by Gynuity and international colleagues on the use of misoprostol for the treatment of postpartum hemorrhage. The findings show:

• Sublingual misoprostol (800 mcg) is a safe, effective and acceptable alternative first-line treatment for PPH due to uterine atony.
• Misoprostol is easy to administer and may be particularly useful in settings where administration of IV oxytocin is not possible, particularly at lower levels of the health care system.
• Simultaneous administration of misoprostol (600 mcg) to conventional uterotonics for PPH treatment confers no clinical advantage.

Results of two of the trials described in this summary were published in The Lancet, Volume 375, Issue 9710, Pages 210 – 216, and Volume 375, Issue 9710, Pages 217 – 223.

This research summary describes the results of a series of clinical trials conducted by Gynuity and international colleagues on the use of misoprostol for the treatment of postpartum hemorrhage. The findings show:

• Sublingual misoprostol (800 mcg) is a safe, effective and acceptable alternative first-line treatment for PPH due to uterine atony.
• Misoprostol is easy to administer and may be particularly useful in settings where administration of IV oxytocin is not possible, particularly at lower levels of the health care system.
• Simultaneous administration of misoprostol (600 mcg) to conventional uterotonics for PPH treatment confers no clinical advantage.

Results of two of the trials described in this summary were published in The Lancet, Volume 375, Issue 9710, Pages 210 – 216, and Volume 375, Issue 9710, Pages 217 – 223.

This research summary describes the results of a series of clinical trials conducted by Gynuity and international colleagues on the use of misoprostol for the treatment of postpartum hemorrhage. The findings show:

• Sublingual misoprostol (800 mcg) is a safe, effective and acceptable alternative first-line treatment for PPH due to uterine atony.
• Misoprostol is easy to administer and may be particularly useful in settings where administration of IV oxytocin is not possible, particularly at lower levels of the health care system.
• Simultaneous administration of misoprostol (600 mcg) to conventional uterotonics for PPH treatment confers no clinical advantage.

Results of two of the trials described in this summary were published in The Lancet, Volume 375, Issue 9710, Pages 210 – 216, and Volume 375, Issue 9710, Pages 217 – 223.

This research summary describes the results of a series of clinical trials conducted by Gynuity and international colleagues on the use of misoprostol for the treatment of postpartum hemorrhage. The findings show:

• Sublingual misoprostol (800 mcg) is a safe, effective and acceptable alternative first-line treatment for PPH due to uterine atony.
• Misoprostol is easy to administer and may be particularly useful in settings where administration of IV oxytocin is not possible, particularly at lower levels of the health care system.
• Simultaneous administration of misoprostol (600 mcg) to conventional uterotonics for PPH treatment confers no clinical advantage.

Results of two of the trials described in this summary were published in The Lancet, Volume 375, Issue 9710, Pages 210 – 216, and Volume 375, Issue 9710, Pages 217 – 223.

This research summary describes the results of a study on the use of misoprostol for the prevention of postpartum hemorrhage conducted in Pakistan.

This research summary describes the results of a study on the use of misoprostol for the prevention of postpartum hemorrhage conducted in Pakistan.

This research summary describes the results of a study on the use of misoprostol for the prevention of postpartum hemorrhage conducted in Pakistan.

This study assessed the relationship between the false positive rapid plasma reagin test and several established clinical and biological markers for thrombophilia and/or autoimmune disease. Access the full abstract at American Journal of Reproductive Immunology (New York, N.Y. : 1989). 01/09/2009; 62(2):73-7.

In recent years, relentless efforts to restrict abortion rights have intersected with an emerging movement to compromise the rights of pregnant women. The well-publicized prosecutions of several women who used misoprostol to self-induce an abortion highlight this intersection. The criminalization of women’s behavior during pregnancy demands a nuanced response from the reproductive justice community, one that differs from responses mobilized to advance abortion access. In particular, responses to the criminalization of abortion self-induction must acknowledge the complex factors that lead women to choose self-induction rather than to seek abortion services from a medical provider.

In August 2009, Gynuity Health Projects and the Reproductive Health Technologies Project convened a meeting of medical providers, lawyers, women’s health advocates, researchers and policymakers to discuss lessons learned in two prosecution cases of women who had used misoprostol without the involvement of medical practitioners. This report presents the major highlights from the meeting and subsequent recommendations for working with the media, the legal and medical communities, and with the reproductive health, rights, and justice communities.

Gynuity is pleased to announce the publication of our new resource for clinicians and women’s health advocates: Misoprostol for Treatment of Incomplete Abortion: An Introductory Guidebook. Misoprostol has many advantages in low-resource settings – it is inexpensive, widely available, thermostable, and offers a low-tech, non-invasive method of uterine evacuation. Based on current scientific evidence, the guidebook offers detailed information about misoprostol for this indication including:

• Efficacy, safety and acceptability;
• Eligibility criteria and precautions;
• Dosing, timing and routes of administration;
• Visit schedule and management of complications;
• Counseling and information provision;
• Integration of misoprostol into existing PAC services.

In April, 2009, the World Health Organization announced the addition of misoprostol to its Model List of Essential Medicines based on its proven safety and efficacy for the treatment of incomplete abortion and miscarriage. The recommendation was made by an expert committee that evaluated available evidence, including numerous randomized comparative clinical trials and several guidelines developed by professional associations for this indication.

This article reports on a study conducted in Nepal with women undergoing medical abortions for gestations through 56 days’ LMP using a regimen of mifepristone followed by misoprostol. Read the full abstract at International Journal of Gynaecology and Obstetetrics 2009 Jul;106(1):39-42. Epub 2009 Apr 5.

This article addresses the safety and efficacy of first trimester abortion methods used in the United States. The author urges health care providers to ensure that all women are aware of and offered the full range of options. The article can be requested by contacting Journal Watch and referencing the full citation Journal Watch Women’s Health, (Jul 2009) Vol. 14(7);51-52.

This article reports results of a study designed to assess knowledge and attitudes towards abortion among women and obstetricians/ gynaecologists in Armenia, in order to facilitate the introduction of medical abortion. View the full abstract at European Journal of Contraception and Reproductive Health Care, (Jul 2009) 25:1-9. [Epub ahead of print].

This article reports on results of a clinical trial evaluating two routes of misoprostol administration following mifepristone for early medical abortion. For gestations through 56 days since last menstrual period 400mcg of oral misoprostol performed better than a 400mcg sublingual dose when following 200mg mifepristone although not significantly so. Access the full abstract at European Society of Contraception and Reproductive Health, (Jun 2009) Vol. 14(3);169-75.

This study, conducted in four clinical sites in Ankara, Turkey, evaluated the efficacy and acceptability of two misoprostol regimens (400 mcg oral or sublingual) following mifepristone for medical abortion for gestations 56 days’ LMP. The results demonstrate the feasibility of integrating medical abortion into health services in Turkey and the potential to increase choices for women. Access the full abstract of this article at European Society of Contraception and Reproductive Health Care, (Jun 2009) Vol. 14(3);169-75.

The third in a series, this Instructions for Use (IFU) brochure on the use of misoprostol for prevention of postpartum hemorrhage was drafted based on current available information. In June 2007, Gynuity invited professionals with epidemiological, clinical and programmatic expertise on PPH prevention and misoprostol to review this document. The aim of this collaborative review was to reach consensus on clinical practice guidelines and make available evidence-based information on appropriate use of misoprostol for this indication. This brochure will be updated as new information and research developments become available.

This study compared misoprostol 600 mcg oral vs. 400 mcg sublingual for the treatment of incomplete abortion. The study was conducted with local colleagues in Madagascar and Moldova. Efficacy rates were 94.6% and 94.5%, for the oral and sublingual routes, respectively.

Access the full abstract at the following link Contraception 79; pp. 456–462.

In this article the role of mid-level health care providers in the provision of first trimester medical abortion care is discussed. The authors emphasize that non-physician providers such as nurses and midwives are well-positioned to offer services and that doing so could greatly expand access to medical abortion for women, especially in rural or remote areas. Access the full abstract at Reproductive Health Matters, 17(33);61-9.