Gynuity Health Projects

Resources

Postpartum Hemorrhage Program Brief

This Program Brief outlines Gynuity’s body of work in the area of postpartum hemorrhage management. The brief is accompanied by an insert listing articles on PPH that have been published in peer-reviewed journals.

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Preventing postpartum hemorrhage at the community level

This one-page document summarizes community-level research showing that misoprostol distributed antenatally for self-administration can be appropriately taken by women delivering at home. The pilot study was conducted in rural Uganda by the University of Liverpool, Gynuity Health Projects, and Makerere University.

The article on which this summary is based is published in BMC Pregnancy and Childbirth and is available here.

A "text only" version is available for users with slower internet connections.

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  • Topic: Postpartum hemorrhage
  • Type: Staff Publication
  • Author: Weeks, A.D., Ditai, J., Ononge, S., Faragher, B., Frye, L.J., Durocher, J., Mirembe, F.M., Byamugisha, J., Winikoff, B., Alfirevic, Z.
  • Published: September 2015

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Postpartum Hemorrhage Program Brief

This Program Brief outlines Gynuity’s body of work in the area of postpartum hemorrhage management. The brief is accompanied by an insert listing articles on PPH that have been published in peer-reviewed journals.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in English

Download

Other Languages Available

Oxytocin in Uniject™ versus misoprostol for prevention of postpartum hemorrhage at the community level: A cluster randomized controlled trial

Where access to conventional injectable uterotonics to prevent PPH is limited, alternative intervention options using uterotonics could play an important role in reducing the incidence of PPH when given to women after childbirth by less skilled providers. This one-page document summarizes a study comparing the programmatic effectiveness and feasibility of misoprostol and oxytocin in Uniject™ for preventing PPH. While both drugs were found to be safe and efficacious, ease of use, higher acceptability and fewer logistical challenges made misoprostol a more adaptable intervention option in rural Senegal, the setting for the study.

The article on which this summary is based is published in Global Health Lancet (Diop et al. 2016) and is available here.

The "text only" version in this language is not currently available.

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Oxytocin in Uniject™ versus misoprostol for prevention of postpartum hemorrhage at the community level: A cluster randomized controlled trial

Where access to conventional injectable uterotonics to prevent PPH is limited, alternative intervention options using uterotonics could play an important role in reducing the incidence of PPH when given to women after childbirth by less skilled providers. This one-page document summarizes a study comparing the programmatic effectiveness and feasibility of misoprostol and oxytocin in Uniject™ for preventing PPH. While both drugs were found to be safe and efficacious, ease of use, higher acceptability and fewer logistical challenges made misoprostol a more adaptable intervention option in rural Senegal, the setting for the study.

The article on which this summary is based is published in Global Health Lancet (Diop et al. 2016) and is available here.

A "text only" version is available for users with slower internet connections.

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Vaginal and Rectal Clostridium sordellii and Clostridium perfringens Presence Among Women in the United States

This observational cohort study evaluated the presence of Clostridium sordellii and Clostridium perfingens of a diverse group of reproductive-aged women in the United States. The results of this study suggest that the chances are exceedingly small that a woman would have C sordelli present in the vagina, that the lethal toxin gene would be present in that particular strain, and that the bacteria would remain long enough for it to produce toxins. At baseline, recent gynecologic surgery was associated with C sordellii presence, whereas a high body mass index was associated with C perfringens presence. Based on the data, use of routine antibiotics at the time of medical abortion would likely not be effective at reducing the presence of clostridia or reducing clostridial infection.

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  • Topic: Abortion
  • Type: Staff Publication
  • Author: Chong, E., Winikoff, B., Charles, D., Agnew, K., Prentice, J.L., Limbago, B.M., Platais, I., Louie, K., Jones, H.E., Shannon, C.
  • Published: February 2016

Effect of Immediate Compared with Delayed Insertion of Etonogestrel Implants on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial

The objective of this study was to evaluate the effects of an etonogestrel implant inserted the same day mifepristone is taken (Quickstart), as compared to the when given after the woman has taken mifepristone (Afterstart); participants were assigned to one of these two groups. Women were followed for 7 months to ascertain abortion outcome, pregnancies, and contraception use. Insertion of etonogestrel implants with mifepristone did not increase the risk of the medical abortion failure, and was shown to enhance patient satisfaction. However, this study found no evidence that it decreased repeat pregnancy rates.

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  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Raymond, E.G., Weaver, M.A., Tan, Y.L., Louie, K.S., Bousiéguez, M., Lugo-Hernández, E.M., Aranguré-Peraza, A.G., Sanhueza, P., Kaplan, C., Sonalkar, S., Goldberg, A.B., Culwell, K.R., Memmel, L., Jamshidi, R., Winikoff, B.
  • Published: February 2016

A systematic review of the relationship between blood loss and clinical signs.

This review examined 30 studies involving women with haemorrhage, 5 of which focused on pregnancy-related haemorrhage, to see if there was a relationship between blood loss and clinical signs that could be used as triggers for clinical interventions. The authors found that there was considerable variability in this relationship. While there was a significant relationship between shock index and blood loss, it is difficult to establish specific cut-off points for other factors to indicate clinical intervention. Further research on the role of the shock index in obstetrics is needed.

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Misoprostol for primary versus secondary prevention of postpartum haemorrhage: a cluster-randomised non-inferiority community trial

The article describes a community trial implemented by a team from India and the USA that compared two approaches to the management of postpartum hemorrhage – the leading complication of childbirth that causes approximately a quarter of all maternal deaths each year. The study compared the current standard, ‘universal prophylaxis’ —a commonly-advocated community approach for reducing postpartum hemorrhage whereby every woman is administered a preventive uterotonic medicine to contract the uterus— to a novel approach, ‘secondary prevention/early treatment’ — where only the small proportion of women who bleed more than average are offered a treatment dose of misoprostol. Results show that the secondary prevention approach medicated substantially fewer women (4.7% versus 99.7%), who experienced significantly fewer side effects. There were no statistical differences in post-delivery hemoglobin levels, rate of postpartum hemorrhage, and rate of transfer to higher level facilities. The authors conclude that this new research shows secondary prevention/early treatment to be a feasible non-inferior alternative strategy to universally medicating all women who deliver with prophylaxis. The approach has the potential for being more acceptable, cost-effective and sustainable, with the additional potential to equip community-level providers with a timely strategy to manage bleeding before it reaches the point of an emergency.

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  • Topic: Postpartum hemorrhage, misoprostol
  • Type: Staff Publication
  • Author: Raghavan, S., Geller, S., Miller, S., Goudar, S.S., Anger, H., Yadavannavar, M.C., Dabash, R., Bidri, S.R., Gudadinni, M.R., Udgiri, R., Koch, A.R., Bellad, M.B., Winikoff, B.
  • Published: January 2016

Oxytocin in Uniject™ versus misoprostol for prevention of postpartum hemorrhage at the community level: A cluster randomized controlled trial

Where access to conventional injectable uterotonics to prevent PPH is limited, alternative intervention options using uterotonics could play an important role in reducing the incidence of PPH when given to women after childbirth by less skilled providers. This one-page document summarizes a study comparing the programmatic effectiveness and feasibility of misoprostol and oxytocin in Uniject™ for preventing PPH. While both drugs were found to be safe and efficacious, ease of use, higher acceptability and fewer logistical challenges made misoprostol a more adaptable intervention option in rural Senegal, the setting for the study.

The article on which this summary is based is published in Global Health Lancet (Diop et al. 2016) and is available here.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

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Sony Reader.

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Contraception Program Brief

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

A "text only" version is available for users with slower internet connections.

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Contraception Program Brief

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

A "text only" version is available for users with slower internet connections (Only available in English at this time)

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(Only English available at this time)

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A "text only" version is available for users with slower internet connections.

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Mifepristone label laws and trends in use: recent experiences in four US states

Since mifepristone was approved in 2000, the rate of medical abortions has risen fairly steadily from just 6% of all eligible abortions in 2001 to 29% in 2011. If unconstrained access to medical abortions were the norm, rather than the exception, medical abortions might constitute a higher percentage of all abortions. Furthermore, the on-label use of mifepristone involves use of an outdated regimen of 600 mg that is more expensive and arguably less effective, with greater side effects than the evidence-based regimen of 200 mg that is currently the world-wide standard of care. In order to examine further the possible effect of mifepristone-specific restrictions, researchers documented trends in mifepristone use over a 10-year period (2004–2014) in four large US states: California, New York, Ohio and Texas.

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Misoprostol for Primary Versus Secondary Prevention of postpartum Haemorrhage: A Cluster-Randomised Non-Inferiority Community Trial

This article describes a cluster-randomized community trial showing ‘secondary prevention’ —a novel approach to PPH management whereby only women who bleed more than average after delivery are given a preemptive treatment dose of misoprostol— to be non-inferior to ‘universal prophylaxis’. The study concludes that this early treatment approach could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level.

A One-page Summary of the research is available here

The "text only" version in this language is not currently available.

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Secondary Prevention/Early Treatment of Postpartum Hemorrhage: An Innovative New Model for PPH Management

This one-page document summarizes community-level research showing ‘secondary prevention’ —a novel approach to PPH management whereby only women who bleed more than average after childbirth are given a preemptive treatment dose of misoprostol— to be a feasible non-inferior alternative strategy to universally medicating all women who deliver with prophylaxis.

The article on which this summary is based is published in the British Journal of Obstetrics and Gynaecology (Raghavan et al. 2015) and is available here

The "text only" version in this language is not currently available.

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If we can do it for misoprostol, why not for mifepristone? The case for taking mifepristone out of the office in medical abortion

Given the highly political nature of abortion in the United States, the provision of medical abortion with mifepristone and misoprostol has always occurred under a unique set of circumstances and restrictions. The current FDA-approved medical abortion regimen requires clinicians to administer mifepristone in the office, and requires women to return to the office for the misoprostol. Six studies, enrolling over 1800 women, found that the option of taking mifepristone out of the office was popular and acceptable among women and providers.

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Continuing pregnancy after mifepristone and "reversal" of first-trimester medical abortion: A systematic review

In early 2015, legislatures in Arizona and Arkansas passed laws requiring physicians providing abortion to inform women that if they choose to have a medical abortion, and decide not to complete the abortion, the effect of mifepristone may be reversed with specific treatment. This systemic literature review looks at the effectiveness of medical abortion “reversal” treatment. Only 1 study met the inclusion criteria for abortion reversal, and 13 studies met criteria for continuing pregnancy after mifepristone alone. The study that looked at reversing the effects of mifepristone was of poor quality and with few details: the mifepristone dosage was not noted, and only six patients had follow-up data. From the dearth of literature surrounding this topic, it is clear that there is insufficient evidence in the literature to determine whether treatment with progesterone after mifepristone results in a higher proportion of continuing pregnancies as compared to expectant management.

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  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Grossman, D., White, K., Harris, L., Reeves, M., Blumenthal, P.D., Winikoff, B., Grimes, D.A.
  • Published: September 2015

Preventing postpartum hemorrhage at the community level

This one-page document summarizes community-level research showing that misoprostol distributed antenatally for self-administration can be appropriately taken by women delivering at home. The pilot study was conducted in rural Uganda by the University of Liverpool, Gynuity Health Projects, and Makerere University.

The article on which this summary is based is published in BMC Pregnancy and Childbirth and is available here.

A "text only" version is available for users with slower internet connections (Only available in English at this time)

Open Text Version in New Window

  • Topic: Postpartum hemorrhage
  • Type: Staff Publication
  • Author: Weeks, A.D., Ditai, J., Ononge, S., Faragher, B., Frye, L.J., Durocher, J., Mirembe, F.M., Byamugisha, J., Winikoff, B., Alfirevic, Z.
  • Published: September 2015

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Cervical Preparation Before Dilation and Evacuation Using Adjunctive Misoprostol or Mifepristone Compared With Overnight Osmotic Dilators Alone: A Randomized Controlled Trial.

This double-blind, three-arm, multicenter, randomized trial compared overnight osmotic dilators alone, dilators plus 400 micrograms buccal misoprostol 3 hours preoperatively, and dilators plus 200 mg oral mifepristone during dilator placement for dilation and evacuation for second trimester abortion. Despite no difference in operative time, adjunctive mifepristone facilitates later dilation and evacuation compared with osmoticdilators alone and is better tolerated than misoprostol.

Obstet Gynecol. 2015 Sep;126(3):599-609. doi: 10.1097/AOG.0000000000000977.

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  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Goldberg, A.B., Fortin, J.A., Drey, E.A., Dean, G., Lichtenberg, E.S., Bednarek, P.H., Chen, B.A., Dutton, C., McKetta, S., Maurer, R., Winikoff, B., Fitzmaurice, G.M.
  • Published: September 2015

Home use of urine pregnancy tests for medical abortion follow-up

This article looks at two unique studies in order to address the question of whether a standard clinic follow-up is truly necessary after medical abortion. The primary reason for a return visit after a medical abortion is to determine whether there is an ongoing pregnancy. However, both studies suggest that home assessment using a multi-level urine pregnancy test?? after a medical abortion is safe, and that, in most cases, a clinic visit is not actually necessary.

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A prospective, non-randomized study of home-use of mifepristone for medical abortion in the U.S.

This prospective, non-randomized, open-label study at six Planned Parenthood centers gave women with pregnancies up to 63 days gestation seeking medical abortion the choice of taking mifepristone in the center or at home. Four hundred women were enrolled in the study, and 32% of those women chose to take mifepristone at home. Ninety-nine percent of home users reported that they would take mifepristone at home again and 96% would recommend home use to a friend. Home use of mifepristone did not increase the burden on service delivery providers.

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Fifteen years: looking back and looking forward

This September marks the fifteenth anniversary of the approval of the sale of mifepristone for medical abortion in the United States. While women in France have had legal access to mifepristone since 1988, it took the United States somewhat longer to approve the drug. In the late ‘90s, the Population Council took on the responsibility of shepherding mifepristone through the FDA approval process in the United States. Though the approval process was a lengthy one, Mifepristone was finally approved in the year 2000. Initially, predictions about the impact of mifepristone were both dire and ecstatic: women would run rampant, having more abortions than ever, boyfriends would slip mifepristone into their girlfriends’ tea, abortion would become simple and easy, women would have access to abortion without any medical interference, and the politics of abortion would soften. While few of these predictions have come true, medical abortion has made a profound change in both the experience of abortion and the landscape of abortion provision.

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Secondary Prevention/Early Treatment of Postpartum Hemorrhage: An Innovative New Model for PPH Management

This one-page document summarizes community-level research showing ‘secondary prevention’ —a novel approach to PPH management whereby only women who bleed more than average after childbirth are given a preemptive treatment dose of misoprostol— to be a feasible non-inferior alternative strategy to universally medicating all women who deliver with prophylaxis.

The article on which this summary is based is published in the British Journal of Obstetrics and Gynaecology (Raghavan et al. 2015) and is available here

A "text only" version is available for users with slower internet connections (Only available in English at this time)

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Outpatient medical abortion is safe and effective through 70 days gestation

Data show that an outpatient regimen of 200-mg mifepristone followed by a single dose of misoprostol is safe and effective for medical abortion for up to 70 days from last menstrual period (LMP). However, many clinics only provide services up to 63 days LMP, and some practice guidelines do not recommend the higher gestational age limit. Updating clinical protocols and revising the Food and Drug administration label for Mifeprex® to change the indication for termination of pregnancies through 70 days LMP will give women more choices and expand access to safe abortion services. Revising the mifepristone label would protect women against antiabortion legislation that requires adherence to an outdated FDA label, and potentially expand access by encouraging the 30% of U.S. physicians who currently do not provide abortions beyond 9 weeks to serve women in later gestation.

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Reaching women where they are

The requirement that every woman desiring medical abortion must come in person to a clinical facility to obtain the drugs is a substantial barrier for many women. To eliminate this requirement in the United States, two key components of the standard initial visit would need to be restructured. First, alternatives to ultrasound and pelvic exam would need to be identified for ensuring that gestational age is within the limit for safe and effective treatment. This is probably feasible: for example, data from a large study suggest that in selected patients menstrual history is highly sensitive for this purpose. Second, the Food and Drug Administration would need to remove the medically unwarranted restriction on distribution of mifepristone. These two changes could allow provision of the service by a broader range of providers in nontraditional venues or even by telemedicine. Such options could have profound benefits in reducing cost and expanding access to abortion.

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Off-label indications for mifepristone in gynecology and obstetrics

This article examines the off-label uses of mifepristone, and describes how it can be used to treat a variety of reproductive health issues. Currently, mifepristone is only approved to induce abortions during the first trimester. However, it is regularly used to help manage second trimester terminations. Research has shown that mifepristone can also be used to help prime the cervix for labor at term. While it is common practice to use other medications off-label, access to mifepristone in the United States has been severely limited by states’ mandates that mifepristone be used strictly in accordance with the label.

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Misoprostol added to the WHO Model List of Essential Medicines for the Treatment of PPH

Misoprostol for the treatment of postpartum hemorrhage (PPH) has been added to the World Health Organisation’s 19th Model List of Essential Medicines (EML). This decision was reached by the 20th Expert Committee on the Selection and Use of Essential Medicines when in April 2015 it met at the WHO Headquarters in Geneva to revise and update the EML for both adults and children. The new edition of the EML recommends the use of misoprostol for the “Prevention and treatment of postpartum haemorrhage where oxytocin is not available or cannot be safely used.”

A proposal for the inclusion of misoprostol for the treatment of PPH was submitted by Gynuity Health Projects for consideration by the Expert Committee. Research has demonstrated that a single sublingual dose of 800mcg (200mcg x 4 tablets) of misoprostol is a safe and effective regimen for the treatment of PPH: nine out of ten women who receive misoprostol after PPH diagnosis will have bleeding controlled (Winikoff 2010; Blum 2010). For further information, see here.

Misoprostol is already included on the EML’s core list because of its proven safety and efficacy for the prevention of PPH, medical abortion (following mifepristone), management of incomplete abortion/miscarriage, and induction of labor.

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Misoprostol added to the WHO Model List of Essential Medicines for the Treatment of PPH

Misoprostol for the treatment of postpartum hemorrhage (PPH) has been added to the World Health Organisation’s 19th Model List of Essential Medicines (EML). This decision was reached by the 20th Expert Committee on the Selection and Use of Essential Medicines when in April 2015 it met at the WHO Headquarters in Geneva to revise and update the EML for both adults and children. The new edition of the EML recommends the use of misoprostol for the “Prevention and treatment of postpartum haemorrhage where oxytocin is not available or cannot be safely used.”

A proposal for the inclusion of misoprostol for the treatment of PPH was submitted by Gynuity Health Projects for consideration by the Expert Committee. Research has demonstrated that a single sublingual dose of 800mcg (200mcg x 4 tablets) of misoprostol is a safe and effective regimen for the treatment of PPH: nine out of ten women who receive misoprostol after PPH diagnosis will have bleeding controlled (Winikoff 2010; Blum 2010). For further information, see here.

Misoprostol is already included on the EML’s core list because of its proven safety and efficacy for the prevention of PPH, medical abortion (following mifepristone), management of incomplete abortion/miscarriage, and induction of labor.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF version:

Download

Download eBook version:

EPUB format for iPad, Nook, and
Sony Reader.

Download

Misoprostol added to the WHO Model List of Essential Medicines for the Treatment of PPH

Misoprostol for the treatment of postpartum hemorrhage (PPH) has been added to the World Health Organisation’s 19th Model List of Essential Medicines (EML). This decision was reached by the 20th Expert Committee on the Selection and Use of Essential Medicines when in April 2015 it met at the WHO Headquarters in Geneva to revise and update the EML for both adults and children. The new edition of the EML recommends the use of misoprostol for the “Prevention and treatment of postpartum haemorrhage where oxytocin is not available or cannot be safely used.”

A proposal for the inclusion of misoprostol for the treatment of PPH was submitted by Gynuity Health Projects for consideration by the Expert Committee. Research has demonstrated that a single sublingual dose of 800mcg (200mcg x 4 tablets) of misoprostol is a safe and effective regimen for the treatment of PPH: nine out of ten women who receive misoprostol after PPH diagnosis will have bleeding controlled (Winikoff 2010; Blum 2010). For further information, see here.

Misoprostol is already included on the EML’s core list because of its proven safety and efficacy for the prevention of PPH, medical abortion (following mifepristone), management of incomplete abortion/miscarriage, and induction of labor.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in English

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Other Languages Available

Misoprostol added to the WHO Model List of Essential Medicines for the Treatment of PPH

This news section describes the addition of misoprostol for the treatment of postpartum hemorrhage (PPH) to the World Health Organization’s 19th Model List of Essential Medicines (EML) in 2015.

The "text only" version in this language is not currently available.

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List of Mifepristone Approvals

Gynuity Health Projects tracks the approval of mifepristone throughout the world. This list reflects our latest information about the registration of this medication. If you become aware of registration in new countries, please write to .(JavaScript must be enabled to view this email address) so we can update the list.

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List of Mifepristone Approvals

Gynuity Health Projects tracks the approval of mifepristone throughout the world. This list reflects our latest information about the registration of this medication. If you become aware of registration in new countries, please write to .(JavaScript must be enabled to view this email address) so we can update the list.

A "text only" version is available for users with slower internet connections.

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List of Mifepristone Approvals

Gynuity Health Projects tracks the approval of mifepristone throughout the world. This list reflects our latest information about the registration of this medication. If you become aware of registration in new countries, please write to .(JavaScript must be enabled to view this email address) so we can update the list.

A "text only" version is available for users with slower internet connections.

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Early Medical Abortion without Prior Ultrasound

This study looked at a recently published systematic review to examine the potential for using the first date of the woman’s last menstrual period (LMP) as a way to estimate gestational age (GA) in order to establish eligibility for medical abortion. The data support the idea that LMP may be an accurate metric for estimating GA, and that this method is promising and should be further investigated.

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Adjunct mifepristone for cervical preparation prior to dilation and evacuation: a randomized trial

This non-inferiority trial compared the procedure times between two groups of women undergoing second trimester surgical abortions. The first group was given one set of osmotic dilators plus mifepristone the day prior to the procedure, while the second group was given two sets of osmotic dilators. Both groups received misoprostol prior to undergoing the procedure. Mifepristone with one set of osmotic dilators and misoprostol did not result in longer procedure times or less cervical dilation than serial (two sets) of osmotic dilators and misoprostol, and has the potential to improve access to second trimester abortion without compromising safety.

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  • Topic: Abortion
  • Type: Staff Publication
  • Author: Shaw, K.A., Shaw, J.G., Hugin, M., Velasquez, G., Hopkins, F.W., Blumenthal, P.D.
  • Published: April 2015

A prospective open-label study of home use of mifepristone for medical abortion in Nepal

This study sought to assess the uptake and acceptability of at-home self-administration of mifepristone for medical abortion in Nepal. The majority of study participants chose to take the mifepristone at home; 98% of these women would recommend home administration to a friend undergoing medical abortion.

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Safety, efficacy and acceptability of outpatient mifepristone-misoprostol medical abortion through 70 days since last menstrual period in public sector facilities in Mexico City

This study assessed the efficacy and acceptability of extending outpatient medical abortion in Mexico City through 70 days’ LMP (one week beyond standard outpatient provision). The overall success rate was very high, and the difference in success between women in the 9th week of pregnancy and women in the 10th week was not statistically significant.

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  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Sanhueza Smith, P., Peña, M., Dzuba, I.G., García Martinez, L.G., Aranguré Peraza, A.G., Bousiéguez, M., Shochet, T., Winikoff, B.
  • Published: February 2015

Acceptability and feasibility of phone follow-up with a semiquantitative urine pregnancy test after medical abortion in Moldova and Uzbekistan

This paper reports on a study that evaluated the feasibility and acceptability of telephone follow-up after medical abortion using an at-home semi-quantitative pregnancy test (SQPT) and checklist, and compared this mode of follow-up with traditional in-clinic assessment. The researchers found that this alternative method of follow-up was indeed feasible and highly effective in identifying ongoing pregnancy.

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The introduction of first trimester medical abortion in Armenia

A series of research activities were undertaken in Armenia to assess the introduction of medical abortion. A clinical study found medical abortion to be acceptable, feasible, and highly effective. Follow-up assessments found that all five of the study sites continued to offer medical abortion after the study was completed, with four of the sites achieving high success rates.

Reproductive Health Matters. 2015 Feb;22(44 Suppl 1):56-66.

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Self-Administration of Misoprostol for Prevention of Postpartum Hemorrhage (PPH)

This instructional pamphlet uses both pictures and text to explain the correct use of misoprostol for the prevention of PPH. It was developed as a tool that organizations or health facilities can use to educate providers, families, and women on how to use misoprostol for prevention of PPH.

The pictorial panels are targeted to illiterate and low-literate audience and the descriptive paragraphs serve to explain the pictures and provide supplementary information. The organization or health facility distributing the pamphlet may include their contact information in the space provided at the top of the sixth panel. (If this PDF is not compatible with your Internet browser and the filling of form fields is not supported, please click the button labeled “Open with different viewer.” This should be located in the right-hand corner of your screen.)

Folding instructions:

1. Fold pamphlet length-wise along the dotted-line in the middle of the paper so the pictures and text face out.

2. Then fold the 6 panels along the dotted vertical lines accordion-style, so all panels lay on top of each other with the title panel in the front and contact information in the back (see pdf link called instructions for additional information).

The "text only" version in this language is not currently available.

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Self-Administration of Misoprostol for Prevention of Postpartum Hemorrhage (PPH)

This instructional pamphlet uses both pictures and text to explain the correct use of misoprostol for the prevention of PPH. It was developed as a tool that organizations or health facilities can use to educate providers, families, and women on how to use misoprostol for prevention of PPH.

The pictorial panels are targeted to illiterate and low-literate audience and the descriptive paragraphs serve to explain the pictures and provide supplementary information. The organization or health facility distributing the pamphlet may include their contact information in the space provided at the top of the sixth panel. (If this PDF is not compatible with your Internet browser and the filling of form fields is not supported, please click the button labeled “Open with different viewer.” This should be located in the right-hand corner of your screen.)

Folding instructions:

1. Fold pamphlet length-wise along the dotted-line in the middle of the paper so the pictures and text face out.

2. Then fold the 6 panels along the dotted vertical lines accordion-style, so all panels lay on top of each other with the title panel in the front and contact information in the back (see pdf link called instructions for additional information).

The "text only" version in this language is not currently available.

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Self-Administration of Misoprostol for Prevention of Postpartum Hemorrhage (PPH)

This instructional pamphlet uses both pictures and text to explain the correct use of misoprostol for the prevention of PPH. It was developed as a tool that organizations or health facilities can use to educate providers, families, and women on how to use misoprostol for prevention of PPH.

The pictorial panels are targeted to illiterate and low-literate audience and the descriptive paragraphs serve to explain the pictures and provide supplementary information. The organization or health facility distributing the pamphlet may include their contact information in the space provided at the top of the sixth panel. (If this PDF is not compatible with your Internet browser and the filling of form fields is not supported, please click the button labeled “Open with different viewer.” This should be located in the right-hand corner of your screen.)

Folding instructions:

1. Fold pamphlet length-wise along the dotted-line in the middle of the paper so the pictures and text face out.

2. Then fold the 6 panels along the dotted vertical lines accordion-style, so all panels lay on top of each other with the title panel in the front and contact information in the back (see pdf link called instructions for additional information).

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF version:

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Sony Reader.

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Knowledge of Abortion Laws and Services among Low-Income Women in Three United States Cities

This paper reports on a survey administered to low-income and minority women to assess their knowledge of abortion laws and services. First-generation immigrants and primarily Spanish speakers were less likely to have correct knowledge than higher-generation or primarily English speakers. More efforts are needed t about abortion, particularly among migrant women and non-primary English speakers.

J Immigrant Minority Health. 2014 Dec 9. [Epub ahead of print]

Access the abstract at: http://www.ncbi.nlm.nih.gov/pubmed/25488893.

Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy

This paper provides a broad overview of emergency contraception. Topics covered include specific methods and regimens, efficacy, side effects, mechanism of action, and population impacts.

Mortality of induced abortion, other outpatient surgical procedures, and common activities in the United States

In response to a multitude of new legislation in the U.S. regulating induced abortion in the guise of protecting women’s health, the authors compared abortion-related mortality to mortality associated with other outpatient surgical procedures as well as some nonmedical activities. Induced abortion in the U.S. is extremely safe and these efforts to regulate it only impede access and potentially harm women.

Contraception 2014 Nov;90(5):476-479.

Access the abstract at: http://www.ncbi.nlm.nih.gov/pubmed/25152259.

Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence

This systematic review commissioned by the WHO updates a review published in 2012 that assessed whether hormonal contraceptives affect the risk of HIV acquisition. As in the original review, the data do not suggest a link between the use of oral contraceptives and increased risk; however, the relationship between progestin-only injectable contraceptives and risk of HIV acquisition continues to be uncertain. Women using injectables should be educated regarding this uncertainty and empowered to use HIV preventative measures.

Contraception. 2014 Oct;90(4):360-90.

Access the full text at: http://www.contraceptionjournal.org/article/S0010-7824(14)00571-X/fulltext.

  • Topic: Contraception
  • Type: Staff Publication
  • Author: Polis, C.B., Phillips, S.J., Curtis, K.M., Westreich, D.J., Steyn, P.S., Raymond, E., Hannaford, P., Turner, A.N.
  • Published: October 2014

DMPA and HIV: do we need a trial?

The relationship between the use of progestin-only injectable contraceptives and the risk of HIV acquisition remains unclear. In this Editorial, the authors discuss the state of knowledge, current research, and the conflicting views of experts. One key issue is whether or not a trial- one designed specifically to examine this relationship- is warranted. The authors present the practical problems with undertaking such a study, and call for much greater discussion on the topic.

Access the full article at: http://www.contraceptionjournal.org/article/S0010-7824%2814%2900611-8/fulltext.

What happens when we routinely give doxycycline to medical abortion patients?

In some settings, antibiotics are routinely prescribed following medical abortion. This study compared side effects among women who received doxycycline to those who did not and evaluated adherence to one prescribed regimen. Adherence was found to be moderate; women who were prescribed doxycycline reported significantly more vomiting than their counterparts.

Access the abstract.

Induction of labour in preeclamptic women: a randomised trial comparing the Foley balloon catheter with oral misoprostol

Between 40,000 and 80,000 pregnant women die each year from pre-eclampsia and eclampsia. While the only cure for these conditions comes with delivery, there are two low-cost interventions commonly used in low-resource settings: oral misoprostol tablets and transcervical Foley catheterization. This randomized, open-label, control trial compared the efficacy, safety, acceptability and cost of those interventions. These methods were compared by assessing and comparing the speed of induction of vaginal delivery, neonatal morbidity and mortality, and maternal complications, mortality and morbidity.

Access the abstract .

  • Topic: Preeclampsia
  • Type: Staff Publication
  • Author: Bracken, H., Mundle, S., Faragher, B., Easterling, T., Haycox, A., Turner, M., Alfirevic, Z., Winikoff, B., Weeks, A.
  • Published: September 2014

Claims of misoprostol use based on blood sampling should be viewed with skepticism

In this Special Communication, the authors warn against the validity of any claims regarding the existence of misoprostol in bodily fluids. Several women have recently been prosecuted for induced abortion based on allegations that they took misoprostol; however, these claims are dubious based on the timing required for accurate assessment as well as the arduous and costly procedures involved with lab testing to determine the presence of misoprostol. Therefore, a high level of scrutiny is needed to substantiate any such claims.

Int J Gynaecol Obstet. 2014 Aug 27. pii: S0020-7292(14)00432-9. doi: 10.1016/j.ijgo.2014.08.006. [Epub ahead of print]

Access the abstract.

Calibrated delivery drape versus indirect gravimetric technique for the measurement of blood loss after delivery: a randomized trial

This study compared measures of blood loss obtained from two different measurement techniques frequently used in studies focusing on the prevention and treatment of post-partum hemorrhage (PPH). Significantly greater mean blood loss was recorded by the direct than by the indirect measurement technique, suggesting a meaningful difference in blood loss measurement between these two methods.

BMC Pregnancy Childbirth. 2014 Aug 15;14(1):276. doi: 10.1186/1471-2393-14-276.

Access the article at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141098/.

First experience of the use of misoprostol as post-abortion care in Libreville, Gabon

The aim of this study was to assess the efficacy and acceptability of 400μg of sublingual misoprostol as first-line treatment of incomplete abortion in Gabon. The rate of successful uterine evacuation was very high (95.7%) as was satisfaction among participants (99.3% satisfied or very satisfied). The findings add to the evidence that this regimen can be successfully introduced in low resource settings.

Pan African Medical Journal 18, 301, 14/08/2014

Access the article at: http://www.panafrican-med-journal.com/content/article/18/301/full/.

Première expérience de l’utilisation du Misoprostol comme soin après avortement (SAA) à Libreville, Gabon.

The aim of this study was to assess the efficacy and acceptability of 400μg of sublingual misoprostol as first-line treatment of incomplete abortion in Gabon. The rate of successful uterine evacuation was very high (95.7%) as was satisfaction among participants (99.3% satisfied or very satisfied). The findings add to the evidence that this regimen can be successfully introduced in low resource settings.

Pan African Medical Journal 18, 301, 14/08/2014.

Link to full article: http://www.panafrican-med-journal.com/content/article/18/301/full/.

Commentary: Evidence versus influence in the WHO procedure for approving essential medicines: misoprostol for maternal health

This letter was written as a response to a commentary stating that misoprostol for PPH prevention was added to the Essential Medicine’s List (EML) not because of evidence supporting its use but because of “influence and vested interest”. Winikoff refutes this argument by citing evidence that supports misoprostol for this use, and by documenting the history of misoprostol advocacy and research that together provide a strong rationale for EML inclusion.

BMJ 2014;349:g4823.

Aceess the link at: http://www.bmj.com/content/349/bmj.g4823/rapid-responses.

Acceptability and feasibility of mifepristone medical abortion in the early first trimester in Azerbaijan

This study examined the acceptability and feasibility of introducing early medical abortion with mifepristone and misoprostol in Azerbaijan. All women were given the option of taking the misoprostol at home, and women in two of the three study sites were also given the option of taking the mifepristone at home. Efficacy and satisfaction were both very high, and a large proportion of women (74% of those eligible) chose home administration of both drugs.

The European Journal of Contraception and Reproductive Health Care, 2014; Early Online: 1–8.

Access the abstract at: http://www.ncbi.nlm.nih.gov/pubmed/25047120.

Efficacy and acceptability of a mifepristone-misoprostol combined regimen for early induced abortion among women in Mexico City

This study aimed to evaluate the experiences of women seeking medical abortion at public sector facilities in a Mexico City district. The mifepristone-misoprostol regimen that was utilized was highly effective and acceptable among study participants.

Access the abstract here.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Peña, M., Dzuba, I.G., Smith, P.S., Mendoza, L.J., Bousiéguez, M., Martínez, M.L., Polanco, R.R., Villalón, A.E., Winikoff, B.
  • Published: June 2014

Mifepristone plus misoprostol or misoprostol-alone for abortion induction in pregnancies 12 - 24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for abortion induction in pregnancies 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone for termination of pregnancies with a live fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in español

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Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

This study sought to increase access to post-abortion care (PAC) services at the community level in Senegal by introducing misoprostol as a first-line treatment. Both efficacy and satisfaction with the regimen were very high, demonstrating that this treatment can be successfully provided by lower level clinicians in community health settings.

Int J Gynaecol Obstet. 2014 May 15. pii: S0020-7292(14)00239-2. doi: 10.1016/j.ijgo.2014.03.028. [Epub ahead of print]

Access the abstract at: http://www.ncbi.nlm.nih.gov/pubmed/24893962.

Medical abortion work in Eastern Europe/Central Asia

This summary describes Gynuity’s body of work in Eastern Europe, the Caucasus, and Central Asia.

A "text only" version is available for users with slower internet connections.

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Medical abortion work in Eastern Europe/Central Asia

This summary describes Gynuity’s body of work in Eastern Europe, the Caucasus, and Central Asia.

A "text only" version is available for users with slower internet connections.

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Download PDF in English

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Medical abortion work in Eastern Europe/Central Asia

This summary describes Gynuity’s body of work in Eastern Europe, the Caucasus, and Central Asia.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

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RU OK? The acceptability and feasibility of remote technologies for follow-up after early medical abortion

This study evaluated the effectiveness and feasibility of using remote technology (text message, online, or phone questionnaire) in lieu of an in-clinic visit to increase the rate of follow-up after early medical abortion. The researchers found that follow-up via remote communication was feasible and preferable for most women.

Contraception. 2014 Apr 13. [Epub ahead of print] pii: S0010-7824(14)00149-8. doi: 10.1016/j.contraception.2014.03.016.

Access the abstract at: http://www.ncbi.nlm.nih.gov/pubmed/24815098.

Acceptability and feasibility of medical abortion with mifepristone and misoprostol in Nigeria

This article reports on a study that sought to examine the acceptability and feasibility of medical abortion in Nigeria. High rates of efficacy and participant satisfaction suggest that this method could be successfully introduced for legal pregnancy termination throughout Nigeria and in other settings with limited access to legal abortion services.

International Journal of Gynecology and Obstetrics. 2014 Apr;125(1):49-52.

Access the abstract at: http://www.ncbi.nlm.nih.gov/pubmed/24507887.

Buccal misoprostol for IUFD Research Group. Buccal misoprostol for treatment of fetal death at 14-28 weeks of pregnancy: a double-blind randomized controlled trial

This study sought to assess whether buccal misoprostol is effective for treating intrauterine fetal death. The authors found that a 200 mcg dose, repeated at 6-hour intervals, was more effective than a 100 mcg dose in evacuating the uterus within 48 hours. Contraception. 2014 Mar;89(3):187-92.

Access abstract at http://www.ncbi.nlm.nih.gov/pubmed/24405797.

  • Topic: Pregnancy Failure
  • Type: Staff Publication
  • Author: Bracken, H., Ngoc, N.T., Banks, E., Blumenthal, P.D., Derman, R.J., Patel, A., Gold, M., Winikoff, B
  • Published: March 2014

A single-arm study to evaluate the efficacy, safety and acceptability of pericoital oral contraception with levonorgestrel

This study sought to reevaluate the potential of pericoital levonorgestrel for pregnancy prevention. The study was stopped early due to low enrollment and feasibility concerns. The Pearl Index (22.4) was higher than expected; additional research could help identify whether the results were regimen or study related. Contraception. 2014 Mar;89(3):215-21.

Access the abstract of this article at http://www.contraceptionjournal.org/article/S0010-7824%2813%2900735-X/abstract.

  • Topic: Contraception
  • Type: Staff Publication
  • Author: Taylor, D.J., Lendvay, A., Halpern, V., Bahamondes, L.G., Fine, P.M., Ginde, S.Y., Wheeless, A., Raymond, E.G.
  • Published: March 2014

Providing Medical Abortion in Low-resource Settings: An Introductory Guidebook, 2nd Edition

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 2nd edition of this resource in PDF was produced in Arabic, English, French, Indonesia, Portuguese, Russian, Spanish, Tamil, Turkish, and Vietnamese. The 1st edition of this resource is still available in Romanian from the drop-down menu.

We are also pleased to announce that this resource is now available to view in E-pub format in English from the drop-down menu.

A "text only" version is available for users with slower internet connections.

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  • Topic: Medical Abortion
  • Type: Clinical Guidelines
  • Author: Abuabara, K., Blum, J. (eds. 1st edition), Bracken, H. (ed. 2nd edition), Gynuity Health Projects
  • Published: May 2004
  • Last Updated: December 2009

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WHO Multicountry Survey on Maternal and Newborn Health Research Network. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health

A secondary analysis of cross-sectional data was conducted to better understand clinical practice, risks, and maternal outcomes associated with postpartum hemorrhage (PPH). The analysis included approximately 275,000 women in 28 countries. The team concluded that even among health care facilities that report having the ability to provide all essential obstetric care, disparities remain in the incidence of severe outcomes among women with PPH.

BJOG. 2014 Mar;121 Suppl 1:5-13.
Access the abstract at: http://www.ncbi.nlm.nih.gov/pubmed/24641530.

Treatment for primary postpartum haemorrhage

This review examined ten randomized clinical trials comparing interventions for the treatment of primary postpartum haemorrhage (PPH), one of the top five causes of maternal mortality. Oxytocin infusion was found to be more effective and cause fewer side effects than misoprostol as a first line of treatment, although the two were similar when used after prophylactic uterotonics. The authors also explore the limitations of the studies reviewed and suggest direction for future studies on PPH treatment.

Cochrane Database Syst Rev. 2014 Feb 13;2:CD003249. doi: 10.1002/14651858.CD003249.pub3.

Access the abstract.

FAQ on Misoprostol Detection in Blood

Recent efforts to prosecute women for induced abortion have included allegations that misoprostol was found in the woman’s blood. This document contains a few critical questions which may help to ascertain if such allegations could be real.

A "text only" version is available for users with slower internet connections.

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FAQ on Misoprostol Detection in Blood

Recent efforts to prosecute women for induced abortion have included allegations that misoprostol was found in the woman’s blood. This document contains a few critical questions which may help to ascertain if such allegations could be real.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in português

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FAQ on Misoprostol Detection in Blood

Recent efforts to prosecute women for induced abortion have included allegations that misoprostol was found in the woman’s blood. This document contains a few critical questions which may help to ascertain if such allegations could be real.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in español

Download

Other Languages Available

FAQ on Misoprostol Detection in Blood

Recent efforts to prosecute women for induced abortion have included allegations that misoprostol was found in the woman’s blood. This document contains a few critical questions which may help to ascertain if such allegations could be real.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF version:

Download

Download eBook version:

EPUB format for iPad, Nook, and
Sony Reader.

Download

Mifepristone plus misoprostol or misoprostol-alone for abortion induction in pregnancies 12 - 24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for abortion induction in pregnancies 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone for termination of pregnancies with a live fetus. The results were compiled 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 "text only" version in this language is not currently available.

Download PDF in português

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Mifepristone plus misoprostol or misoprostol-alone for treatment of intrauterine fetal death 12-24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for treatment of intrauterine fetal death 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone to induce fetal and placental expulsion with a demised fetus. The results were compiled 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 "text only" version in this language is not currently available.

Download PDF in português

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Mifepristone plus misoprostol or misoprostol-alone for treatment of intrauterine fetal death 12-24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for treatment of intrauterine fetal death 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone to induce fetal and placental expulsion with a demised fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in español

Download

Other Languages Available

Mifepristone plus misoprostol or misoprostol-alone for treatment of intrauterine fetal death 12-24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for treatment of intrauterine fetal death 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone to induce fetal and placental expulsion with a demised fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

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Mifepristone plus misoprostol or misoprostol-alone for abortion induction in pregnancies 12 - 24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for abortion induction in pregnancies 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone for termination of pregnancies with a live fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in français

Download

Other Languages Available

Mifepristone plus misoprostol or misoprostol-alone for treatment of intrauterine fetal death 12-24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for treatment of intrauterine fetal death 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone to induce fetal and placental expulsion with a demised fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in English

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Other Languages Available

Mifepristone plus misoprostol or misoprostol-alone for treatment of intrauterine fetal death 12-24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for treatment of intrauterine fetal death 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone to induce fetal and placental expulsion with a demised fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF version:

Download

Download eBook version:

EPUB format for iPad, Nook, and
Sony Reader.

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Mifepristone plus misoprostol or misoprostol-alone for abortion induction in pregnancies 12 - 24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for abortion induction in pregnancies 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone for termination of pregnancies with a live fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF in English

Download

Other Languages Available

Mifepristone plus misoprostol or misoprostol-alone for abortion induction in pregnancies 12 - 24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for abortion induction in pregnancies 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone for termination of pregnancies with a live fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

Open Text Version in New Window

Download PDF version:

Download

Download eBook version:

EPUB format for iPad, Nook, and
Sony Reader.

Download

Mifepristone plus misoprostol or misoprostol-alone for abortion induction in pregnancies 12 - 24 weeks’ LMP

Gynuity Health Projects convened an expert meeting in 2013 looking at the use of mifepristone and misoprostol for abortion induction in pregnancies 12-24 weeks’ LMP. Professionals with epidemiological, clinical and programmatic expertise reached consensus on the appropriate use of mifepristone and misoprostol or misoprostol-alone for termination of pregnancies with a live fetus. The results were compiled 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.

A "text only" version is available for users with slower internet connections.

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Is One Of These Things Not Just Like The Other? Why Abortion can’t be Separated from Contraception

In this commentary, Dr. Winikoff discusses how family planning advocates have long worked to separate abortion from contraception in the minds of the public and legislature. She provides a history of the separation, and discusses how this strategy to keep contraception clear of the negative connotations associated with abortion has backfired.

Conscience. 2014;35(3):27-29.

Access the article at: http://digital.graphcompubs.com/publication/?i=226388&p=28.

Acceptability and feasibility of phone follow-up after early medical abortion in Vietnam: a randomized controlled trial

This study investigated the use of telephone follow-up combined with a semiquantitative urine pregnancy test and symptom checklist as a possible replacement for in-clinic follow-up after medical abortion. While telephone follow-up was very effective, the pregnancy test alone provided higher specificity in screening for ongoing pregnancy.

Obstet Gynecol. 2014 Jan;123(1):88-95.

Access the abstract of this article at: http://www.ncbi.nlm.nih.gov/pubmed/24463668.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Ngoc, N.T., Bracken, H., Blum, J., Nga, N.T., Minh, N.H., van Nhang, N., Lynd, K., Winikoff, B., Blumenthal, P.D.
  • Published: January 2014

Infertility

This document outlines causes of infertility in both men and women, and includes information about infertility screening, diagnosis, and treatment.

The "text only" version in this language is not currently available.

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Reproductive Tract Cancers

This document outlines the symptoms of various reproductive tract cancers (cervical, uterine, prostate, and testicular cancers), as well as risk factors, detection, treatment, and prevention strategies.

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  • Topic: Cancer
  • Type: Fact Sheet
  • Author: Gynuity Health Projects
  • Published: December 2013

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Pregnancy Termination/Abortion

This document defines abortion, outlines the available methods for terminating pregnancy, and offers warning signs and guidance for care after abortion.

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  • Topic: Abortion
  • Type: Fact Sheet
  • Author: Gynuity Health Projects
  • Published: December 2013

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Pregnancy, Delivery, and Post-Natal Care

This document addresses the biology of pregnancy and pre-natal development, as well as relevant topics for pregnant women such as guidance about pre-natal care, and information about miscarriage. It provides insight into labor and delivery, including the stages of labor, vaginal, and caesarian section deliveries. This document also highlights issues in post-natal care, such as postpartum depression, physical pain, recovery in the postpartum period, contraception, and birth spacing.

The "text only" version in this language is not currently available.

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Pregnancy, Delivery, and Post-Natal Care

This document addresses the biology of pregnancy and pre-natal development, as well as relevant topics for pregnant women such as guidance about pre-natal care, and information about miscarriage. It provides insight into labor and delivery, including the stages of labor, vaginal, and caesarian section deliveries. This document also highlights issues in post-natal care, such as postpartum depression, physical pain, recovery in the postpartum period, contraception, and birth spacing.

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Menstruation

This document addresses issues about the menstrual cycle, answers questions and dispels myths about menstruation, and provides guidance for parents about preparing their children for menarche.

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Infertility

This document outlines causes of infertility in both men and women, and includes information about infertility screening, diagnosis, and treatment.

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HIV/AIDS

This document contains information about HIV, the infection that causes AIDS. It also addresses the symptoms of HIV, the disease’s progressive stages, courses of treatment, and includes recommendations for patient support.

The "text only" version in this language is not currently available.

  • Topic: STIs/HIV
  • Type: Fact Sheet
  • Author: Gynuity Health Projects
  • Published: December 2013

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HIV/AIDS

This document contains information about HIV, the infection that causes AIDS. It also addresses the symptoms of HIV, the disease’s progressive stages, courses of treatment, and includes recommendations for patient support.

A "text only" version is available for users with slower internet connections (Only available in العربية at this time)

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  • Topic: STIs/HIV
  • Type: Fact Sheet
  • Author: Gynuity Health Projects
  • Published: December 2013

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Female Genital Mutilation

This document describes the forms of female genital mutilation, as well as the socio-culture reasons for the procedure. This page also elaborates on the potential health consequences of female genital mutilation.

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Family Planning

This document provides guidance on a comprehensive range of family planning methods, as well as information for patients about the mechanisms, side effects, instructions for use, and benefits and drawbacks of each method.

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Emergency Contraceptives

This document offers information about the three available forms of emergency contraception: combined emergency contraceptive pills, progestin-only emergency contraceptive pills, and the copper intra-uterine device. The document details the circumstances which may require the use of emergency contraception, an explanation of how each method works, instructions for use, efficacy rates, and side-effects.

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Child Health

This document addresses risks, symptoms, causes, and treatment of various causes of child illness, morbidity, and mortality. Important issues in newborn care are also included, such as feeding, sleeping, and caring for the umbilical cord.

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Breast Cancer

This document covers a range of topics related to breast cancer diagnosis including risk factors, prevention, screening (self-exam, clinical exam, and mammogram), symptoms, diagnosis, and treatment. The page also includes practical materials for both patients and providers, guidance for performing self-exams, and links to online resources about the prevention and management of breast cancer.

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  • Topic: Cancer
  • Type: Fact Sheet
  • Author: Gynuity Health Projects
  • Published: December 2013

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Youth Issues in Reproductive Health

This document provides information on a range of issues in reproductive health affecting youth. It discusses puberty, sexual and reproductive health education, youth-friendly healthcare services, HPV vaccination, and the effects of early marriage.

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