Gynuity Health Projects

This chapter, published in A Comprehensive Textbook of Postpartum Hemorrhage: An Essential Clinical Reference for Effective Management. 2nd Edition. Sapiens Publishing, 2012, describes the evidence to date for the use of sublingual misoprostol for the treatment of postpartum hemorrhage. The full chapter can be downloaded from the menu and is available at the Global Library of Women’s Medicine.

This article reports on a study evaluating a medical abortion regimen in an outpatient setting through 70 days gestational age. The results demonstrate the efficacy, acceptability and feasibility of the evaluated regimen in the context of outpatient services. Read the full abstract at Obstetrics and Gynecology (Nov 2012). Vol. 120 (5):1070-76.

This article reports on a study evaluating a medical abortion regimen that entails taking both mifepristone and misoprostol at the woman’s home. The results demonstrate a high acceptability of this option for both women and providers. Read the full abstract at Contraception (Nov 2012). In press.

This article reports data from multi-site randomized trials comparing 400 mcg misoprostol to standard surgical care for treatment of incomplete abortion in 5 sub-Saharan African countries: Burkina Faso, Mauritania, Niger, Nigeria and Senegal. The results provide additional evidence for the misoprostol regimen evaluated and demonstrate the feasibility of its use in this context. Read the abstract and provisional PDF here BMC Pregnancy and Childbirth. (Nov 2012). Vol 12:127.

This article reports on the results of a trial evaluating the delivery of magnesium sulfate by a mechanical pump for treatment of preeclampsia. The authors conclude that the SpringFusor pump may offer an alternative to intramuscular administration of magnesium sulfate where electronic pumps are not available. The full article can be downloaded from the drop-down menu or read at Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012):32–38.

This tool was developed for program planners and trainers of clinical providers who are interested in the introduction of misoprostol for incomplete abortion services. It describes evidence-based regimens and practical considerations for introducing the method as part of postabortion care services, especially as related to low-resource settings.

The training guide offers a range of ways to prepare health care providers to introduce the method, including detailed information on
• 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 postabortion care (PAC) services

The guide includes a CD-ROM to guide delivery of didactic information.

This tool was developed for program planners and trainers of clinical providers who are interested in the introduction of misoprostol for incomplete abortion services. It describes evidence-based regimens and practical considerations for introducing the method as part of postabortion care services, especially as related to low-resource settings.

The training guide offers a range of ways to prepare health care providers to introduce the method, including detailed information on
• 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 postabortion care (PAC) services

The guide includes a CD-ROM to guide delivery of didactic information.

This chapter, published in A Comprehensive Textbook of Postpartum Hemorrhage: An Essential Clinical Reference for Effective Management. 2nd Edition. Sapiens Publishing, 2012, describes the evidence to date for the use of sublingual misoprostol for the treatment of postpartum hemorrhage. The full chapter can be downloaded from the menu and is available at the Global Library of Women’s Medicine.

This study aimed to explore 400 mcg sublingual misoprostol as primary treatment in lower-level facilities with no previous experience providing postabortion care. The results demonstrated that misoprostol is a viable option for treatment of incomplete abortion at mid-level facilities. Access the full article here International Journal of Gynecology and Obstetrics (2012), V119:166-169 or download from menu.

This commentary discusses the important advance in modern abortion care that is the use of medications for pregnancy termination. The authors provide examples of its use in both legal and restrictive settings, private and public sectors, and by women themselves. Read the full article here International Perspectives on Sexual and Reproductive Health (2012), Vol 38(3):164-66 or download from the menu.

This Special Communication discusses some of the benefits and limitations of current community approaches using misoprostol for postpartum hemorrhage prevention and presents a new hybrid model of “secondary prevention”—presumptive treatment for women with more than average blood loss—as one alternative community-based approach. Read the full abstract here International Journal of Gynecology and Obstetrics (Dec 2012) Vol 119(3):210-12.

The aim of this study was to determine the feasibility of introducing misoprostol as first-line treatment for incomplete abortion at a secondary-level health facility in Nigeria. The results demonstrate that misoprostol can be successfully used as first-line treatment by nurse–midwives, with success rates over 90% that are consistent with findings from previous studies in which drug administration was controlled solely by physicians. International Journal of Gynecology and Obstetrics (2012), 119:170–173. Access the article at this link or download from menu.

The aim of this study was to determine the feasibility of introducing misoprostol as first-line treatment for incomplete abortion at a secondary-level health facility in Nigeria. The results demonstrate that misoprostol can be successfully used as first-line treatment by nurse–midwives, with success rates over 90% that are consistent with findings from previous studies in which drug administration was controlled solely by physicians. International Journal of Gynecology and Obstetrics (2012), 119:170–173. Access the article at this link or download from menu.

This study aimed to explore 400 mcg sublingual misoprostol as primary treatment in lower-level facilities with no previous experience providing postabortion care. The results demonstrated that misoprostol is a viable option for treatment of incomplete abortion at mid-level facilities. Access the full article here International Journal of Gynecology and Obstetrics (2012), V119:166-169 or download from menu.

This operations research was undertaken to assess the efficacy of medical abortion and patient satisfaction in the clinic setting, in addition to determining healthcare providers’ views in Vietnam. The results demonstrate the safety, efficacy, and acceptability of medical abortion at participating clinics. The majority of surveyed providers endorsed adding medical abortion at their own facilities. Read the full abstract here International Journal of Gynecology and Obstetrics (2012) V19:39-43.

Misoprostol is an effective and safe uterotonic for the prevention and treatment of postpartum hemorrhage (PPH). A 600-mcg oral dose of misoprostol has been shown to prevent PPH in community-based randomized controlled trials. An 800-mcg sublingual dose of misoprostol appears to be a good first-line treatment for controlling PPH. Adverse effects after use of misoprostol for PPH prevention or treatment may include shivering and fever. These effects are transient, resolve on their own, and are not life threatening. Misoprostol can play an important role in settings with limited access to oxytocin, and where there is no other option for PPH care. Read the full text of this article here International Journal of Gynecology and Obstetrics, V119:S35–S38 or download from the menu to the right.

Misoprostol is an effective and safe uterotonic for the prevention and treatment of postpartum hemorrhage (PPH). A 600-mcg oral dose of misoprostol has been shown to prevent PPH in community-based randomized controlled trials. An 800-mcg sublingual dose of misoprostol appears to be a good first-line treatment for controlling PPH. Adverse effects after use of misoprostol for PPH prevention or treatment may include shivering and fever. These effects are transient, resolve on their own, and are not life threatening. Misoprostol can play an important role in settings with limited access to oxytocin, and where there is no other option for PPH care. Read the full text of this article here International Journal of Gynecology and Obstetrics, V119:S35–S38 or download from the menu to the right.

This commentary discusses the important advance in modern abortion care that is the use of medications for pregnancy termination. The authors provide examples of its use in both legal and restrictive settings, private and public sectors, and by women themselves. Read the full article here International Perspectives on Sexual and Reproductive Health (2012), Vol 38(3):164-66 or download from the menu.

Medical abortion in the United States requires clinic-based follow-up, representing additional time and cost to women and clinics. This study evaluated a semi-quantitative home pregnancy test as a possible replacement for in-person follow-up. The results demonstrate that at-home follow-up with a semi-quantitative pregnancy test is feasible for service delivery in the United States. Read the full abstract here Contraception (in press).

The dose of mifepristone approved by most government agencies for medical abortion is 600 mg. The aim of this review was to summarize extant data on the effectiveness and safety of regimens using the widely recommended lower mifepristone dose, 200 mg, followed by misoprostol in early pregnancy and to explore potential correlates of abortion failure. Read the full abstract at Contraception (in press).

This trial sought to evaluate the potential advantages of combined mifepristone–misoprostol versus misoprostol-only for earlymedical abortion. The study was double-blind randomized placebo controlled and enrolled 441 pregnant women (<63 days LMP). The mifepristone–misoprostol group (n=220) received 200 mg of mifepristone on day 1 and 800 μg buccal misoprostol followed by placebo 3 hours later on day 2. The misoprostol-only group (n=221) received placebo on day 1 and 1600 μg of misoprostol (2 doses of 800 μg, given 3 hours apart) on day 2. The results demonstrated that the combined regimen was significantly more effective than the misoprostol-only protocol for early medical abortion. Read the full abstract at International Journal of Gynecology and Obstetrics 118 (2012) 166–171.

This article evaluates the risk of venous thromboembolism associated with combined oral contraceptives based on a review of the literature. The authors offer recommendations to patients, clinicians and policy makers based on their conclusions. Read the abstract here Obstetrics and Gynecology. (May 2012);119(5):1039-44.

Gynuity and Planned Parenthood Global conducted an introductory project in the Hospital San Juan de Dios de Amatitlán, Guatemala, that aimed to introduce misoprostol as an alternative to standard surgical treatment for incomplete abortion. Over 100 women were treated with an outpatient misoprostol protocol during the period of introduction in 2011. The vast majority of women completed their abortion with medication alone, and most women reported being satisfied with the method. This project summary describes the project background and primary results.

Gynuity and Planned Parenthood Global conducted an introductory project in the Hospital San Juan de Dios de Amatitlán, Guatemala, that aimed to introduce misoprostol as an alternative to standard surgical treatment for incomplete abortion. Over 100 women were treated with an outpatient misoprostol protocol during the period of introduction in 2011. The vast majority of women completed their abortion with medication alone, and most women reported being satisfied with the method. This project summary describes the project background and primary results.

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 commentary describes common rationales for the use of feticidal digoxin prior to surgical abortion, evaluates existing scientific literature, and highlights related ethical issues. The article can be obtained at Contraception, (Feb 2012), Vol.85(2):140-143.

This review article describes the available evidence for the use of misoprostol for the prevention and treatment of postpartum hemorrhage (PPH). The authors argue that a solid body of evidence exists to justify the use of misoprostol for both indications. Read the full abstract here Expert Opin Investig Drugs. 2012 Feb;21(2):235-50.

This article evaluates the safety of legal abortion compared to childbirth in the United States. The authors conclude that childbirth results in greater morbidity and mortality than legal induced abortion. Read the abstract at Obstetrics and Gynecology (Feb 2012) Vol 119(2, Part 1): 215-219.

This article reports on a study comparing two doses of buccal misoprostol (400 mcg vs. 800 mcg) after mifepristone for early medical abortion. The results demonstrate that both regimens achieve 96% efficacy through 63 days’ gestation. Read the full abstract at Contraception (2012) Vol 86(3): 251-256.

In this commentary Winikoff and Sheldon emphasize that “it is precisely where abortion is illegal that it must become safer” and note “the public health community will not be able to address maternal mortality adequately and attainment of Millennium Development Goals is questionable until we directly confront the issue of unsafe abortion”. They also call for a re-examination of the definition of unsafe abortion that take into consideration innovations in abortion care such as medical abortion.

In this commentary Winikoff and Sheldon emphasize that “it is precisely where abortion is illegal that it must become safer” and note “the public health community will not be able to address maternal mortality adequately and attainment of Millennium Development Goals is questionable until we directly confront the issue of unsafe abortion”. They also call for a re-examination of the definition of unsafe abortion that take into consideration innovations in abortion care such as medical abortion.

This article outlines existing challenges to evidence-based use of misoprostol for prevention and treatment of postpartum hemorrhage, and suggests strategies for increasing access to appropriate use for these indications. Read the full article at International Journal of Gynecology and Obstetrics (Dec 2012),116:1–3.

This article reports on the results of a series of focus group discussions aimed at evaluating provider perspectives regarding influencing factors for the use of magnesium sulfate for treatment of eclampsia and pre-eclampsia in India. The abstract can be read at International Journal of Gynecology and Obstetrics 115 (2011) 231–234.

Gynuity Health Projects tracks the approval of misoprostol throughout the world. This map 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).

This study aimed to assess the feasibility of introducing misoprostol for the treatment of incomplete abortion in Quito, Ecuador. The results demonstrated that a single oral dose of 600 mcg of misoprostol was an acceptable and effective non-surgical option for this indication in this setting. Read the full abstract at International Journal of Gynecology & Obstetrics, (Nov 2011) 115(2):135-139.

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.

Gynuity and partners have been working since 2004 on a program of research with support from the Bill & Melinda Gates Foundation to help establish the safety, efficacy, and appropriateness of misoprostol for prevention and treatment of postpartum hemorrhage (PPH) in a variety of clinical settings. In 2009, in collaboration with partners, Gynuity embarked on a follow-up initiative to answer remaining research questions, address operational and service-delivery issues related to misoprostol’s applications including at the community-level, and influence policies and clinical practice guidelines to better reflect the evidence and promote appropriate use. This project description provides results of the initiative to date and planned activities under the new grant.

Gynuity and partners have been working since 2004 on a program of research with support from the Bill & Melinda Gates Foundation to help establish the safety, efficacy, and appropriateness of misoprostol for prevention and treatment of postpartum hemorrhage (PPH) in a variety of clinical settings. In 2009, in collaboration with partners, Gynuity embarked on a follow-up initiative to answer remaining research questions, address operational and service-delivery issues related to misoprostol’s applications including at the community-level, and influence policies and clinical practice guidelines to better reflect the evidence and promote appropriate use. This project description provides results of the initiative to date and planned activities under the new grant.

Gynuity and partners have been working since 2004 on a program of research with support from the Bill & Melinda Gates Foundation to help establish the safety, efficacy, and appropriateness of misoprostol for prevention and treatment of postpartum hemorrhage (PPH) in a variety of clinical settings. In 2009, in collaboration with partners, Gynuity embarked on a follow-up initiative to answer remaining research questions, address operational and service-delivery issues related to misoprostol’s applications including at the community-level, and influence policies and clinical practice guidelines to better reflect the evidence and promote appropriate use. This project description provides results of the initiative to date and planned activities under the new grant.

Gynuity and partners have been working since 2004 on a program of research with support from the Bill & Melinda Gates Foundation to help establish the safety, efficacy, and appropriateness of misoprostol for prevention and treatment of postpartum hemorrhage (PPH) in a variety of clinical settings. In 2009, in collaboration with partners, Gynuity embarked on a follow-up initiative to answer remaining research questions, address operational and service-delivery issues related to misoprostol’s applications including at the community-level, and influence policies and clinical practice guidelines to better reflect the evidence and promote appropriate use. This project description provides results of the initiative to date and planned activities under the new grant.

Gynuity and partners have been working since 2004 on a program of research with support from the Bill & Melinda Gates Foundation to help establish the safety, efficacy, and appropriateness of misoprostol for prevention and treatment of postpartum hemorrhage (PPH) in a variety of clinical settings. In 2009, in collaboration with partners, Gynuity embarked on a follow-up initiative to answer remaining research questions, address operational and service-delivery issues related to misoprostol’s applications including at the community-level, and influence policies and clinical practice guidelines to better reflect the evidence and promote appropriate use. This project description provides results of the initiative to date and planned activities under the new grant.

Gynuity and partners have been working since 2004 on a program of research with support from the Bill & Melinda Gates Foundation to help establish the safety, efficacy, and appropriateness of misoprostol for prevention and treatment of postpartum hemorrhage (PPH) in a variety of clinical settings. In 2009, in collaboration with partners, Gynuity embarked on a follow-up initiative to answer remaining research questions, address operational and service-delivery issues related to misoprostol’s applications including at the community-level, and influence policies and clinical practice guidelines to better reflect the evidence and promote appropriate use. This project description provides results of the initiative to date and planned activities under the new grant.

Gynuity and partners have been working since 2004 on a program of research with support from the Bill & Melinda Gates Foundation to help establish the safety, efficacy, and appropriateness of misoprostol for prevention and treatment of postpartum hemorrhage (PPH) in a variety of clinical settings. In 2009, in collaboration with partners, Gynuity embarked on a follow-up initiative to answer remaining research questions, address operational and service-delivery issues related to misoprostol’s applications including at the community-level, and influence policies and clinical practice guidelines to better reflect the evidence and promote appropriate use. This project description provides results of the initiative to date and planned activities under the new grant.

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 results of a trial evaluating the delivery of magnesium sulfate by a mechanical pump for treatment of preeclampsia. The authors conclude that the SpringFusor pump may offer an alternative to intramuscular administration of magnesium sulfate where electronic pumps are not available. The full article can be downloaded from the drop-down menu or read at Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012):32–38.

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

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

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.

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

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.