Misoprostol

MISOPROSTOL is a safe method for clandestine abortion.

MISOPROSTOL is a prostaglandin that acts at cervico-uterine level and facilitates emptying or evacuation on the basis of a softening action on the uterine neck or cervix and on the contractility of the uterine muscle.
In the cases of seeking the expulsion of an UNwanted pregnancy, it is used ALONE or as contributory prostaglandin to MIFEPRISTONE (RU 486), for an induced medical abortion.

There are still countries where MIFEPRISTONE does not exist and induced abortion is illegal and is practiced in a clandestine manner, high risk for the health of the woman.
In these situations and countries, MISOPROSTOL is an adequate answer and solution which reduces maternal morbid-mortality from high risk, clandestine abortions.

In these cases and countries, basic and fundamental information must be given to the general public and women in particular.

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• MISOPROSTOL should NOT be used prior to confirming the weeks of the pregnancy, in order to discount an Ectopic Pregnancy and confirm the weeks of gestation (success is inverse, less weeks, greater success).
• The method of administration does not affect the result, the difference may be that when administered sublingually its effect is greater, but shorter, and when administered vaginally it has less effect but longer duration and the side effects are reduced by at least some 90%.
• The DOSE has a limit from which, however many MISOPROSTOL pills are used, the results will not improve.

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For this reason, of GREAT IMPORTANCE are the information and support programmes that exist in some countries (Uruguay for example) to prevent high risk, clandestine abortions and continue with the application and control of methods for avoiding UNwanted maternity, and/or a repeat induced abortion. In countries where abortion is penalised, Misoprostol ensures that the morbid-mortality rates are doing down.
In some countries such as Argentina, Ecuador, El Salvador, etc, there are groups of a civil and/or hospital nature which provide information to avoid high risk abortions, some of the doses are, up to 9 weeks: 4 pills vaginally every 12 hours, three times, or 4 pills sublingually every 3 hours, three times. From 13 to 15 weeks, 2 pills sublingually every 3 hours, up to a maximum of 5 times.

In Brazil, the Technical Regulations for Humane Treatment of Abortion (2.005), indicate that Misoprostol is available.

In Peru, Prostokos is the commercial name authorised by Directive 1.988 of 20/February/2.003, and a technical report 23 -2.005 and the General Directorate for Medication, Medical Supplies and Drugs considers, together with the Pharmacological Committee for Maternal and Perinatal Health, of Misoprostol:
Its use is justified in incomplete abortions but is NOT justified for the treatment of post-partum uterine haemorrhage nor the treatment of the maturation of the uterine neck to induce birth in the third trimester.

In URUGUAY, the Ministry of Public Health authorised Misoprostol for its use in Obstetrics (inducing birth with immature uterine neck, dead egg and retained foetal death, premature rupture of membranes and post-partum haemorrhages) and in Gynaecology (for cervical dilation in hysterectomies, D and C’s and in gynaecological surgery), there is also programme of HEALTHCARE INITIATIVES, which recommends Misoprostol for inducing abortion at up to 9 weeks gestation in the following doses:
Vaginal 4 pills of 200 mg. every/12 hours. Up to 3 times.
Oral 4 pills of 200 mg every 3 hours. Up to 3 times.
With 80% success within 24 hours and 90% success in 72 hours.

Other countries such as COLOMBIA and those that follow the Essar Foundation standards, up to 9 weeks, the doses are:
(In places where the use of Metotrexate is approved, it is initially used:
50 mg per m2 of body surface (oral or IM), and Misoprostol after 72 hours with a dose of 800 mcg vaginally every 24 hours, twice.
With Misoprostol alone, first use Ibuprofen 800 mg one hour prior to beginning the treatment, followed by 400 mg every 3 hours up to 5 more times, then Misoprostol 800 mg sublingually every 3 hours, three times 800 mg every 12 hours, for three times.

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DOSES based on scientific research and evidence:

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• 400 mg every 2 or 4 hours or also 600-800 mg every 6 or 8 hours, with a maximum of 2.400 mg. Success rates range from 80 to 95%.
• According to FLASOG: up to 12 weeks: 4 pills vaginally every 12 hours, 3 times, 12 in total, or 4 pills under the tongue every 3 hours, 3 times, 12 at the most.
  From 13 to 15 weeks, place two pills under the tongue every 3 hours up to a MAXIMUM of FIVE times. The woman must stop taking the pills and be admitted when she starts to lose blood.
  From 16 to 20 weeks, (take ultrasound ¿?, Placenta Previa). Place two pills under the tongue every 3 hours up to a MAXIMUM of FIVE times. The woman must stop taking the pills and be admitted when she starts to lose blood.
• Each MISOPROSTOL pill, has only 0.2 % of active product.

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Flasog indications (spanish)

In Latin America FLASOG (Latin American Foundation of Obstetric and Gynaecological Societies) has published a text with the use and indications for Misoprostol in Toco-Gynaecology.

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Misoprostol in Spain

In SPAIN, MISOPROSTOL has been in existence since 1.986 in CITOTEC, of 200 mg, for the treatment and prevention of gastro-duodenal ulcers.
In the year 2.008, THE SPANISH DRUGS AGENCY authorised the following:

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• MISOFAR 25 mg vaginally for inducing birth
• MISOFAR 200 mg vaginally for the dilation of the cervix, (IUD, Hysterectomies).
• MISIVE 200 mg vaginally for:
  -abortive use up to 7 weeks, on its own or with MIFEPRISTONE .
  -Pharmacological treatment of spontaneous abortion.
  -For the dilation and preparation of the cervix prior to surgical abortion of the 1st and 2nd trimester.
  -Inducement of birth in the event of intra-uterine foetal death.
  -Pharmacological abortion of 2nd trimester.

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See related subjects

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• See “A Solas” documentary report on Misoprostol
• Medical abortion
• See recommended links on Misoprostol (spanish)

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