Pregnancy Failure and Miscarriage
Of all recognized pregnancies, 15-20% are spontaneously miscarried and an additional 22% end in induced abortion. Incomplete abortion occurs when products of conception are partially expelled from the uterus; and either spontaneous or induced pregnancy loss can result in incomplete abortion. Women seeking care following incomplete abortion are faced with the inadequacy of existing safe abortion and postabortion care services. In countries where access to safe abortion services is restricted, abortions may be performed by unskilled providers in poor conditions and incomplete abortion is of particular concern.
The occurrence of spontaneous fetal death after the first trimester is difficult to ascertain but one estimate is that, in the United States alone, approximately 125,000 to 190,000 2nd- and 3rd-trimester fetal deaths occur each year. Common therapies for 2nd trimester intra-uterine fetal death (IUFD) include dilatation and evacuation surgery and non-surgical labor-induction agents; their use depends in part on gestational age and provider skills and method preference. At this stage of pregnancy, the nonviable fetus is often not spontaneously evacuated, yet timely evacuation is vital in order to avoid the possibility of serious complications for the woman.
We invite you to learn about our approach to pregnancy failure in the first and second trimesters of pregnancy.
Misoprostol for Treatment of Early Pregnancy Failure
In many contexts treatment of incomplete and missed abortion involves either curettage or vacuum aspiration. Though highly effective these surgical procedures require trained providers, special equipment, sterile conditions, and often anesthesia. In settings with limited access to these essential supplies and conditions, the use of misoprostol for uterine evacuation is an attractive alternative. Medical management of early pregnancy failure is safe, effective, has a low incidence of side effects, and is highly acceptable to women.
Gynuity implemented an extensive portfolio of research on optimal doses and routes of misoprostol administration for incomplete abortion and conducted feasibility studies in a range of settings including Sub-Saharan Africa, Latin America and the Caribbean, and Eastern Europe/Former Soviet Union.
Misoprostol for Treatment of Intra-uterine Fetal Death in the Second Trimester
Because of the scarcity of well-trained surgical providers, more and more clinicians turn to misoprostol as an alternative approach to surgical evacuation of the uterus after fetal death in the 2nd trimester. Misoprostol has been demonstrated to be as effective as, or more effective than, either oxytocin or other prostaglandins for this indication in a number of small trials published in the peer-reviewed literature. In many contexts misoprostol has become the accepted standard of care for 2nd trimester intrauterine fetal death, however, dosages and routes are not standardized nor are timing of doses and total dose.
Gynuity has conducted research on the efficacy, safety and acceptability of different misoprostol regimens and the use of mifepristone as pre-treatment for this indication.
Partnerships for Policy and Practice
Abortion and Postabortion Care (APAC) Consortium
Gynuity has been active in the Abortion and Postabortion Care (APAC) Consortium and its activities for over 6 years, collaborating with multiple partners to facilitate knowledge sharing and foster dialogue to promote evidence-based practices that meet women’s needs for contraception, abortion and postabortion care. Gynuity is a member of APACC’s 8 international agency steering committee along with Ipas, Pathfinder, EngenderHealth, MSI, PSI, JHPEIGO and Intrahealth. We have taken the lead on and collaborated on a range of activities, including planning a series of Webinars and technical meetings to inform best practices globally.
Communications for Impact
Translation of critical evidence for diverse audiences
Gynuity synthesizes evidence into user-friendly clinical guidelines and materials for clinicians and women’s health advocates. We evaluate, compile and disseminate evidence on promising technologies and service delivery models. In the area of pregnancy failure we produced a Guidebook and Instructions for Use brochure series that outline regimen options for use of misoprostol for uterine evacuation in early pregnancy and for intrauterine fetal death.
Given our extensive research in the area of misoprostol for early pregnancy failure, we created a large set of resources for use at the community level, pictorial images that can be used to create materials for low literacy populations to reinforce key messages about how to use misoprostol regimens. These are accessible for download via our Image Bank.
- Buccal misoprostol for treatment of fetal death at 14-28 weeks of pregnancy: a double-blind randomized controlled trial
- Mife plus miso or miso-alone for treatment of intrauterine fetal death 12-24 weeks’ LMP
- Misoprostol for Treatment of Incomplete Abortion: A Training Guide
- Guidebook on Misoprostol for Treatment of Incomplete Abortion
- Pregnancy Failure and Miscarriage Program Brief
- Misoprostol for Incomplete Abortion and Miscarriage