Gynuity Health Projects

Resources

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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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 English

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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

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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:

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Download eBook version:

EPUB format for iPad, Nook, and
Sony Reader.

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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.

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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 (Only available in English at this time)

Open Text Version in New Window

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(Only English available at this time)

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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

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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 (Only available in English at this time)

Open Text Version in New Window

Download PDF version:
(Only English available at this time)

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A two-pill sublingual misoprostol outpatient regimen following mifepristone for medical abortion through 70 days' LMP: a prospective comparative open-label trial

This study examined the efficacy and acceptability of a medical abortion regimen using mifepristone and sublingual misoprostol, and compared the effectiveness at 64-70 days’ LMP to that at 57-63 days’ LMP. Neither the rates of success not the rates of ongoing pregnancy differed significantly between the two gestational age groups, suggesting that this regimen can be offered up to 70 days’ LMP.

Contraception. 2013 Nov 26. pii: S0010-7824(13)00736-1. doi: 10.1016/j.contraception.2013.11.014. [Epub ahead of print]

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Bracken, H., Dabash, R., Tsertsvadze, G., Posohova, S., Shah, M., Hajri, S., Mundle, S., Chelli, H., Zeramdini, D., Tsereteli, T., Platais, I., Winikoff, B.
  • Published: November 2013

Repeat use of Emergency Contraception in Kenya: Letter to the editor

This letter responds to an article reporting on a published survey of women purchasing emergency contraception (EC) at pharmacies in Kenya. One of the key findings of the article is the high number of women who had already used EC that same month. This letter identifies a sampling bias in the methodology that led to an overestimation of this finding. A reanalyzation of the survey data is suggested. (no abstract available)

Letter to the editor on Emergency Contraception

This letter is a response to a published case report of an ectopic pregnancy following use of levonorgestrel emergency contraception (EC) wherein the authors argue that EC may increase the risk of ectopic pregnancy. This letter provides evidence that this is not the case, and asserts that use of EC may in fact lower the risk of ectopic pregnancy. (no abstract available)

Misoprostol for Treatment of Incomplete Abortion: A Training Guide

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, including a series of PowerPoint presentations. The slide sets can be found at the end of the PDFs.

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

Medical abortion: A path to safe, high-quality abortion care in Latin America and the Caribbean

Abortion rates in Latin America and the Caribbean (LAC) are very high and methods are often unsafe. This paper offers evidence that the use of medical abortion could reduce abortion-related morbidity and mortality, despite strict abortion laws. The authors address ways to improve medical abortion services and discuss the many remaining barriers to access in this region.

Access the full abstract at The European Journal of Contraception and Reproductive Health Care, (Sep 2013); Early Online: 1–10.

Embracing post-fertilisation methods of family planning: a call to action

In this commentary, the authors present an argument for developing a family planning method that could be used after fertilization. Such a method could be used later after sex than emergency contraceptives and could possibly be used only when a woman’s menstrual period is delayed. While there would likely be political fallout, a post-fertilization method would likely appeal to many women and thus efforts to produce such a method would be worthwhile.

Access the full abstract at J Fam Plann Reprod Health Care 2013 Oct;39(4):244-6. doi: 10.1136/jfprhc-2013-100702.

  • Topic: Contraception
  • Type: Staff Publication
  • Author: Raymond, E.G., Coeytaux, F., Gemzell-Danielsson, K., Moore, K., Trussell, J., Winikoff, B.
  • Published: August 2013

Postpartum bleeding is reduced with sublingual powdered misoprostol when compared with oxytocin injection, but a new formulation of misoprostol is unlikely to revolutionise postpartum haemorrhage care.

This commentary responds to the findings of a study that compared powered sublingual misoprostol with oxytocin injection for prevention of postpartum haemorrhage. The study authors reported a lower rate of PPH with the misoprostol than with the oxytocin and called for research using sublingual misoprostol tablets. Winikoff and Durocher present contradictory evidence from a large body of literature and suggest that given the unusually high rate of PPH and bleeding with the oxytocin, the quality of the oxytocin may have been subpar. Of greater benefit would be to focus on integrating these two drugs (with already established formulations) as appropriate, particularly in low-resource settings.

Access the abstract at Evid Based Med. 2013;18(4):143-4.

Acceptability of home use of mifepristone for medical abortion

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 (Jul 2013). Vol 88(1):122-127.

Prophylactic compared with therapeutic Ibuprofen analgesia in first-trimester medical abortion: a randomized controlled trial

This article reports on a study that sought to compare the efficacy of two ibuprofen regimens (therapeutic vs. prophylactic) in first-trimester abortion. Women assigned to both groups reported high levels of pain. Prophylactic use of ibuprofen did not appear to lessen the length or severity of pain.

Obstet Gynecol. 2013 Sep;122(3):558-64. doi: 10.1097/AOG.0b013e31829d5a33.
Abstract available at: http://blog.psiimpact.com/2013/06/psi-honors-champions-in-womens-health-at-the-2013-impact-awards/.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Raymond, E.G., Weaver, M.A., Louie, K.S., Dean, G., Porsch, L., Lichtenberg, E.S., Ali, R., Arnesen, M.
  • Published: June 2013

Map of Mifepristone Approvals

Gynuity Health Projects tracks the approval of mifepristone 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).

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

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Map of Mifepristone Approvals

Gynuity Health Projects tracks the approval of mifepristone 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).

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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Other Languages Available

Acceptability and Feasibility of Mifepristone-Misoprostol For Menstrual Regulation in Bangladesh

Using pills instead of vacuum aspiration for menstrual regulation could increase access to services and reduce high levels of related morbidity in Bangladesh. This study investigated the efficacy and acceptability (to both women and providers) of using a mifepristone-misoprostol regimen for menstrual regulation. Findings include high levels of success and patient satisfaction. Providers became more comfortable with the method after gaining experience.

International Perspectives on Sexual and Reproductive Health (June 2013). Vol 39 (2):79-87.

Full article available at www.guttmacher.org/pubs/journals/3907913.pdf.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Alam, A., Bracken, H., Johnston, H. B., Raghavan, S., Islam, N., Winikoff, B., Reichenbach, L.
  • Published: June 2013

Social marketing of emergency contraception: Are we missing a valuable opportunity?

This editorial explores provision of emergency contraceptive pills (ECPs) by international social marketing organizations. The authors conducted a survey of 4 large social marketing organizations and found that only one third of their family planning programs include provision of ECPs. The authors identify several key barriers to increased EC provision and discuss possible strategies to address them.

Contraception 2013;87(6):703-705. (no abstract)

Results from a study using misoprostol for management of incomplete abortion in Vietnamese hospitals

This study investigated the use of 400 mcg sublingual misoprostol for uterine evacuation following incomplete abortion. In addition to evaluating efficacy and acceptability, the study sought to demonstrate the applicability of this method in lower level settings. Findings include high rates of success and satisfaction and suggest a clear path for task shifting post-abortion care from physicians to lower- or midlevel providers.

BMC Pregnancy Childbirth. 2013 May 22;13:118. doi: 10.1186/1471-2393-13-118.

Full article available at http://www.biomedcentral.com/content/pdf/1471-2393-13-118.pdf.

Simplified medical abortion using a semi-quantitative pregnancy test for home-based follow-up

Medical abortion follow-up typically includes a return visit to the clinic, adding to both the cost and time required of women and providers. This study examined the efficacy and ease of use of a semi-quantitative pregnancy test (SQPT) used at home to identify ongoing pregnancy following medical abortion. All ongoing pregnancies were successfully identified by the SQPT, and most women found the test easy to use.

Access the full abstract at International Journal of Gynecology & Obstetrics. 2013;121(2):144-148.

Cost-effectiveness of increased access to emergency contraceptive pills: probably not.

This Letter to the Editor provides a response to a recent article in which the authors argued that increased use of emergency contraceptive pills (ECPs) would be cost effective due to the subsequent reduction in unintended pregnancies. Raymond et al. provide evidence to the contrary: that extensive research in this area has yet to produce any real evidence of such an effect.

Contraception. 2013;87(4):504. (no abstract)

Efficacy and acceptability of early mifepristone-misoprostol medical abortion in Ukraine: Results of two clinical trials

This paper reports on two studies that were conducted to improve service delivery of medical abortion in Ukraine by introducing updated, evidence-based regimens. Both studies demonstrated high efficacy and acceptability, as well as a preference for home administration of the misoprostol. The Ukraine Ministry of Health has since updated the national medical abortion protocol to reflect these findings.

Access the full abstract at The European Journal of Contraception and Reproductive Health Care. 2013 Apr;18(2):112-9.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Raghavan, S., Maistruk, G., Shochet, T., Bannikov, V., Posohova, S., Zhuk, S., Lishchuk, V., Winikoff, B.
  • Published: April 2013

Use of 400 μg of sublingual misoprostol after mifepristone for medical abortion up to 63 days since the last menstrual period: Evidence from Uzbekistan.

This study sought to assess the feasibility and acceptability of introducing medical abortion up to 63 days’ LMP in Uzbekistan, with the option of home administration of misoprostol. Findings include a high success rate and high acceptability among participants. In addition, almost all women chose to administer the misoprostol at home.

Access the full abstract at The European Journal of Contraception and Reproductive Health Care. 2013 Apr;18(2):104-11.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Raghavan, S., Tsereteli, T., Kamilov, A., Kurbanbekova, D., Yusupov, D., Kasimova, F., Jymagylova, D., Winikoff, B.
  • Published: April 2013

Misoprostol for Treatment of Incomplete Abortion: A Training Guide

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, including a series of PowerPoint presentations. The slide sets can be found at the end of the PDFs.

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

Postpartum hemorrhage: Moving from Research to Reality

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

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Estimating contraceptive efficacy: the case of spermicides

The contraceptive efficacy of certain contraceptives, including vaginal spermicides, can be difficult to assess. This paper presents and evaluates available data on spermicides and discusses their implications. In addition, the authors call for further discussion of how to satisfactorily evaluate methods such as this that are only moderately effective in preventing pregnancy.

Contraception (Feb 2013) Vol. 87, Issue 2, Pages 134-137. (no abstract)

First-trimester medical abortion with mifepristone 200 mg and misoprostol: A systematic review

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 (Jan 2013) Vol. 87(1):26-37.

Armenia: A Way to Make Abortion Safer. EurasiaNet commentary.

Abortion services are widely available in Armenia. However, riskier surgical methods- often with outdated approaches- are much more readily available than are medical regimens. This commentary reviews abortion provision in Armenia, describes the noted preference for home administration of medical methods by Armenian women, and calls for greater provider training in evidence-based medical abortion methods.

Published online 1/9/13 Eurasianet.org.

Can at-home semi-quantitative pregnancy tests serve as a replacement for clinical follow-up of medical abortion? A US study.

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 (Dec 2012); Vol. 86(6):757-762.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Blum, J., Shochet, T., Lynd, K., Lichtenberg, S., Fischer, D., Arnesen, M., Winikoff, B., Blumenthal, P.D.
  • Published: December 2012

Sublingual Misoprostol for the Treatment of Postpartum Hemorrhage

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 the entire textbook is available at the Global Library of Women’s Medicine.

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

Download PDF in English

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Extending outpatient medical abortion services through 70 days of gestational age

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.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Winikoff, B., Dzuba, I.G., Chong, E., Goldberg, A.B., Lichtenberg, E.S., Ball, C., Dean, G., Sacks, D., Crowden, W.A., Swica, Y.
  • Published: November 2012

Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

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. Download the PDF here BMC Pregnancy and Childbirth (Nov 2012). Vol 12:127.

Treatment approaches for preeclampsia in low-resource settings: A randomized trial of the Springfusor pump for delivery of magnesium sulfate

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.

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

  • Topic: Pre-eclampsia
  • Type: Staff Publication
  • Author: Mundle, S., Regi, A., Easterling, T., Biswas, B., Bracken, H., Khedekare, V., Shekhavat, D.R., Durocher, J., Winikoff, B.
  • Published: October 2011

Download PDF in English

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Other Languages Available

Misoprostol for Treatment of Incomplete Abortion: A Training Guide

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, including a series of PowerPoint presentations. The slide sets can be found at the end of the PDFs.

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

Misoprostol for Treatment of Incomplete Abortion: A Training Guide

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, including a series of PowerPoint presentations. The slide sets can be found at the end of the PDFs.

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

Sublingual Misoprostol for the Treatment of Postpartum Hemorrhage

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 the entire textbook is available at the Global Library of Women’s Medicine.

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

Download PDF version:
(Only English available at this time)

Download

Download

Oral misoprostol as first-line care for incomplete abortion in Burkina Faso

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.

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

  • Topic: Pregnancy Failure
  • Type: Staff Publication
  • Author: Blandine, T., Ouattara, A.Z., Coral, A., Hassane, C., Clotaire, H., Dao, B., Lankoande, J., Diop, A., Blum, J.
  • Published: October 2012

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Use of Medicines Changing the Face of Abortion

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.

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

Download PDF in English

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Misoprostol for the management of postpartum bleeding: A new approach

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.

Misoprostol as first-line treatment for incomplete abortion at a secondary-level health facility in Nigeria

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

Download PDF in English

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Misoprostol as first-line treatment for incomplete abortion at a secondary-level health facility in Nigeria

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.

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

Download PDF version:
(Only English available at this time)

Download

Download

Oral misoprostol as first-line care for incomplete abortion in Burkina Faso

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.

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: Pregnancy Failure
  • Type: Staff Publication
  • Author: Blandine, T., Ouattara, A.Z., Coral, A., Hassane, C., Clotaire, H., Dao, B., Lankoande, J., Diop, A., Blum, J.
  • Published: October 2012

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Clinic-level introduction of medical abortion in Vietnam

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 for prevention and treatment of postpartum hemorrhage: What do we know? What is next?

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.

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Misoprostol for prevention and treatment of postpartum hemorrhage: What do we know? What is next?

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.

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Controlled cord traction in active management of the third stage of labour (comment)

This comment responds to the conclusions of a study that examined controlled cord traction as part of active management of the third stage of labor. While the study concluded that controlled cord traction can be omitted without increasing the incidence of severe postpartum hemorrhage, Sheldon and Winikoff note that all women in the study were given oxytocin prophylaxis and argue that these findings may not apply in settings where oxytocin prophylaxis is not part of standard care.

Access the full text at the following link The Lancet. 2012;380(9848):1146.

Use of Medicines Changing the Face of Abortion

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.

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A randomized controlled trial of different buccal misoprostol doses in mifepristone medical abortion

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.

Dose and side effects of sublingual misoprostol for treatment of postpartum hemorrhage: What difference do they make?

This article reports on a study to assess whether a 600 mcg sublingual dose of misoprostol would reduce the incidence of shivering and high fever seen in a previous study that used an 800 mcg sublingual regimen to treat postpartum hemorrhage in Ecuador. While the rate of both shivering and fever remained the same, the incidence of high fever was 55% lower than in the previous study. However, without substantial evidence regarding efficacy of the lower dose, the 800 mcg regimen is still recommended.

Read the full abstract at BMC Pregnancy Childbirth. 2012 Jul 7;12:65 doi: 10.1186/1471-2393-12-65..

Comparison of misoprostol-only and combined mifepristone–misoprostol regimens for home-based early medical abortion in Tunisia and Vietnam

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.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Blum J., Raghavan S., Dabash R., Ngoc N.T.N., Chelli H., Hajri S., Conkling K., Winikoff B.
  • Published: June 2012

Combined hormonal contraceptives and venous thromboembolism: putting the risks into perspective

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.

Misoprostol for Incomplete Abortion in Guatemala

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

  • Topic: Pregnancy Failure
  • Type: Project Description
  • Author: Ministerio de Salud Publica y Asistencia Social, Hospital Nacional de Amatitlan, Planned Parenthood Global, Gynuity Health Projects
  • Published: March 2012

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Misoprostol for Incomplete Abortion in Guatemala

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.

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  • Topic: Pregnancy Failure
  • Type: Project Description
  • Author: Ministerio de Salud Publica y Asistencia Social, Hospital Nacional de Amatitlan, Planned Parenthood Global, Gynuity Health Projects
  • Published: March 2012

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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.

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Feticidal digoxin injection before dilation and evacuation abortion: Evidence and ethics

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.

Misoprostol for the prevention and treatment of postpartum hemorrhage

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.

The comparative safety of legal induced abortion and childbirth in the United States

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.

Abortion: What is the problem?

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.

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Abortion: What is the problem?

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.

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

This abstract summarizes a study to assess the efficacy, safety, and acceptability of oral levonorgestrel used pericoitally by women who have infrequent sex. The rates of pregnancy were higher than expected; further research is needed to assess whether this method of contraception could be recommended for women with low to moderate frequency of intercourse.

Contraception. 2012;86(3):313. [Conference abstract- abstract not available.]

  • Topic: Contraception
  • Type: Staff Publication
  • Author: Lendvay, A., Taylor, D., Halpern, V., Bahamondes, L., Fine, P., Ginde, S., Raymond, E.
  • Published: January 2012

Misoprostol for postpartum hemorrhage: Moving from evidence to practice

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.

Facility and personnel factors influencing magnesium sulfate use for eclampsia and pre-eclampsia in 3 Indian hospitals

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.

Map of Misoprostol Approvals

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).

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Oral Misoprostol for the Management of Incomplete Abortion in Ecuador

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.

  • Topic: Pregnancy Failure
  • Type: Staff Publication
  • Author: Montesinos, R., Durocher, J., Leon, W., Arellano, M., Peña, M,, Pinto, E., Winikoff, B.
  • Published: November 2011

The Product Problem: Pathways for Making Misoprostol Available for Postpartum Hemorrhage

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.

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The Product Problem: Pathways for Making Misoprostol Available for Postpartum Hemorrhage

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.

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Postpartum hemorrhage: Moving from Research to Reality

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.

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Postpartum hemorrhage: Moving from Research to Reality

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.

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

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Postpartum hemorrhage: Moving from Research to Reality

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.

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

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Postpartum hemorrhage: Moving from Research to Reality

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.

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Postpartum hemorrhage: Moving from Research to Reality

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.

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Postpartum hemorrhage: Moving from Research to Reality

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.

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Postpartum hemorrhage: Moving from Research to Reality

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.

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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.

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Treatment approaches for preeclampsia in low-resource settings: A randomized trial of the Springfusor pump for delivery of magnesium sulfate

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.

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  • Topic: Pre-eclampsia
  • Type: Staff Publication
  • Author: Mundle, S., Regi, A., Easterling, T., Biswas, B., Bracken, H., Khedekare, V., Shekhavat, D.R., Durocher, J., Winikoff, B.
  • Published: October 2011

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Mifepristone and Misoprostol Compared With Misoprostol Alone for Second-trimester Abortion: A Randomized Controlled Trial

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.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Ngoc, N.T.N., Shochet, T., Raghavan, S., Blum, J., Nga, N.T.B., Minh, N.T.H., Phan, V.Q., Winikoff, B.
  • Published: September 2011

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.

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Review of the literature on patient satisfaction with early medical abortion using mifepristone and misoprostol

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.

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.

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

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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.

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

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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.

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

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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.

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Reference List - 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 "text only" version in this language is not currently available.

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Reference List - 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 "text only" version in this language is not currently available.

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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.

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

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.

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

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Download PDF version:

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Sony Reader.

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Comparing two early medical abortion regimens: Mifepristone+misoprostol vs. misoprostol alone

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.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Ngoc, N.T.N., Blum, J., Raghavan, S., Nga, N.T.B., Dabash, R., Diop, A., Winikoff, B.
  • Published: April 2011

Medical abortion for adolescents

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.

Introduction and provision of medical abortion: A tale of two countries in which technology is necessary but not sufficient.

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.

Exploration of a new procedure for sterilization by intrauterine instillation of a methylcellulose gel.

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.

  • Topic: Contraception
  • Type: Staff Publication
  • Author: Raymond, E.G., Ramchandani, P., Shaunik, A., Lendvay, A., Sokal, D., Barnhart, K.T.
  • Published: March 2011

Pericoital Oral Contraception with Levonorgestrel: A Systematic Review

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.

Administration of 400 μg of misoprostol to augment routine active management of the third stage of labor

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

  • Topic: Postpartum Hemorrhage
  • Type: Staff Publication
  • Author: Hofmeyr, G.J., Fawole, B., Mugerwa, K., Godi, N.P., Blignaut, Q., Mangesi, L., Singata, M., Brady, L., Blum, J.
  • Published: February 2011

Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone–misoprostol

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.

  • Topic: Medical Abortion
  • Type: Staff Publication
  • Author: Bracken, H., Clark, W., Lichtenberg, E.S., Schweikert, S.M., Tanenhaus, J., Barajas, A., Alpert, L., Winikoff, B.
  • Published: January 2011

Administration of misoprostol by trained traditional birth attendants to prevent postpartum haemorrhage in homebirths in Pakistan: A randomised placebo-controlled trial

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

Oral misoprostol as an alternative to surgical management for incomplete abortion in Ghana

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.

Progestin-only Pills

Contraceptive Technology is a guide to contraceptive methods written for clinicians. This chapter provides detailed information on progestin-only contraceptive pills. Topics covered include mechanism of action, effectiveness, and the advantages and disadvantages of using this method.

More information on the text can be found at Contraceptive Technology. 20th edition. New York: Ardent Media, Inc., 2011..

  • Topic: Contraception
  • Type: Staff Publication
  • Author: Raymond, E.G., Hatcher, R.A., Trussell, J., Nelson, A., Cates, W., Kowal, D., Policar, M.
  • Published: January 2011