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Gynuity conducted an comparative study of two different doses of misoprostol to treat incomplete abortion in a hospital setting. The study compared a 400 mcg sublingual dose to a 600 mcg oral dose. Results showed a 94% efficacy rate for both regimens, with no difference between the routes suggesting that a reduced dose of 400 mcg misoprostol can be equally as effective and less costly than a 600 mcg oral dose. These results, after presentation to officials from the Ministry of Health, resulted in the incorporation of a 400 mcg sublingual misoprostol regimen for the treatment of incomplete abortion into the national Reproductive Health Norms and Protocols. The next phase of work in Madagascar will include a project in four hospitals to expand the use of misoprostol for incomplete abortion to lower levels of the health care system. We will examine the use of misoprostol as a first line treatment in community level health centers as well as document the use of misoprostol for this indication by lower level health providers, including nurses and midwives.

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