Revised and Expanded Guidance on Misoprostol Only Recommended Regimens

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

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

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

New Indication: Secondary Prevention of PPH

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

Route of Administration

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

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

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