Gynuity Health Projects


Revised and Expanded Guidance on Misoprostol-Only Recommended Regimens


In Brief: Revised and Expanded Guidance on Misoprostol-Only Recommended Regimens

The International Federation of Gynecology and Obstetrics (FIGO) has updated its guidance on misoprostol-only regimens for several obstetric and gynecologic indications. The “FIGO Misoprostol-only Recommended Regimens 2017” chart — published in the International Journal of Gynecology and Obstetrics, accompanied by a commentary — is the result of extensive collaboration between an international expert group, including Gynuity Health Projects. The chart, divided by stages of pregnancy, provides recommendations for dosages and routes of administration for misoprostol use in obstetrics and gynecology, including: medically induced abortion, medical management of miscarriage, cervical preparation for surgical abortion, fetal death, induction of labor, and management of postpartum hemorrhage (PPH).

Gynuity welcomes the guidance and hopes the chart will be widely disseminated and used by a full range of providers. We support the development and implementation of evidence-based policy and programs to broaden access and availability of misoprostol for each of its women’s health indications.

New Indication: Secondary Prevention of PPH

The chart, last revised in 2012, has been expanded to include a new indication for PPH management — secondary prevention of PPH — based on evidence from Gynuity’s trials. Secondary prevention of PPH is a new strategy that has been shown to be a comparable alternative to the established universal prophylaxis approach in two large community trials (Raghavan and in press). Rather than medicating all women with a prophylactic dose immediately after delivery, a single 800mcg dose placed under the tongue is used to treat only women with above-average blood loss (approximately 350mL or more).

Route of Administration

The chart includes alternative routes for taking misoprostol. In most cases, this has meant the addition of the buccal (in the cheek) route which has a similar pharmacokinetic profile* to the vaginal route. Alternative routes increase available options for providers and enable women’s preferences to be taken into account. The chart does not include the rectal route – using this route is not recommended as the pharmacokinetic profile is not associated with the best efficacy.

[*A measure of drug absorption, distribution, metabolism and elimination by the body.]


The “FIGO Misoprostol-only Recommended Regimens 2017” chart is available in English, French, Spanish and Portuguese.

Gynuity Health Projects is a research and technical assistance organization which works globally to ensure that reproductive and maternal health technologies are widely available at reasonable cost, provided in the context of high-quality services, and offered in a way that recognizes the dignity and autonomy of each individual. Our efforts are focused particularly on resource-poor environments, underserved populations, and challenging subject matter. For further information, visit our website and follow us on Twitter @Gynuity.

ICM Triennial Congress 2017


Toronto, Canada, June 18-22, 2017

Please join us for these events

Gynuity Health Projects and FIGO
Expert Panel on Innovations in Postpartum Hemorrhage Management
New technologies and models for facilitating timely management of PPH at all levels of care

Exhibit Halls F&G: Tuesday June 20 @ 2:00-3:30pm

This expert panel will introduce new interventions and models of PPH management that could help expand access to essential, life-saving care to women across a variety of settings. Presentations in English & Spanish, with simultaneous interpretation.

Moderated by Beverly Winikoff, Gynuity Health Projects

  • New models of PPH management using misoprostol at the community level. Nusrat Jehan, Pakistan
  • Is an ounce of PPH treatment worth a pound of prevention? Implications of research from India and Egypt comparing primary prevention to secondary prevention/early treatment of PPH. Rasha Dabash, USA
  • The role of condom uterine-balloon tamponade in PPH management: A community stepped-wedged trial in secondary level referral facilities in Egypt, Senegal and Uganda. Holly Anger, USA
  • Time to rethink how we diagnose and treat PPH? The role of shock index in PPH diagnosis ¿Tiempo para reconsiderar cómo se identifica y maneja HPP? El rol del índice de shock en el diagnóstico de HPP. Dr Daniel Aguirre, Argentina

Expert Panel on Global Models of Abortion and Postabortion Care

Global models, new evidence and recommendations supporting the critical role of midwives and other health providers in improving access to abortion care

Exhibit Halls F&G: Wednesday June 21 @ 11:00am-12:30pm

This expert panel will present case studies and innovations from different settings demonstrating how country programs can move towards implementing WHO guidelines on expanding health worker roles for abortion and postabortion care. Presentations in English, French & Spanish, with simultaneous interpretation.

Moderated by Anna Maria Speciale, Pathfinder International

  • Midwives and nurse midwives as providers of abortion and postabortion care at the primary care level: Lessons learned from Egypt and Tunisia. Rasha Dabash, USA
  • Senegal’s national program to expand postabortion care to the primary care level Le programme national sur l’extension des soins après-avortement au niveau communautaire au Sénégal. Birima Ndao Ndiaye, Senegal
  • The role of Lady Health Visitors in expanding access to menstrual regulation and postabortion care: Evidence from Pakistan. Dina Abbas, USA
  • Involving midwives when abortion is in transition: Evidence from Mexico Integrando a las parteras cuando el aborto está en transición: el caso de México. Maricruz Coronado, Mexico

Breakfast Event on ICM Competency 7

Competency Seven in Practice: Case Studies in Abortion-related Care for Pregnancy Termination or Loss

Tuesday, June 20 @ 7:00 – 8:15am | Room 717B
Breakfast will be served

Gynuity, as a member of APACC, is collaborating on a session on ICM Competency 7 – facilitation of abortion-related care. This interactive session will hear from midwives practicing across contexts and present clinical cases in abortion-related care for pregnancy termination or loss, including postabortion care. It will offer an opportunity to share experiences from different care settings in multiple countries, gain clinical knowledge, and clarify points of confusion. Certificates of participation will be awarded. This event is organized by Abortion and Postabortion Care Consortium (APACC), formerly the Postabortion Care Consortium. Please RSVP to .(JavaScript must be enabled to view this email address).

Full details about the Congress are available from the International Confederation of Midwives website.