Misoprost for labor initiation, abortion and postpartum hemorrhage

Misoprost is a Misoprostol local brand available ,in Egypt, in form of tablets that can be used orally or vaginally. Misoprost produced by Chemical Industries Development Company (CID) for Multi -Pharma. Misoprost is a local alternative to the brand Cytotec.

 Early medical abortion or chemical abortion and cervical softening are the most common indication of Misoprost pills. Misoprost can also be prescribed for the prevention of stomach ulcers that may result from the use of analgesic drugs. Misoprostol is the active ingredient in Misoprost tablets (each tablet contains 200 micrograms Misoprostol).

misoprost tablet is misoprostol product by CID for multipharm- composition in EN
misoprost tablet is misoprostol product by CID for multipharm- composition in EN

What is medical abortion

Medical or home abortion is a procedure performed by pregnant women to terminate their pregnancy using abortive drugs (e.g. Misoprost). Abortion pills often succeed in terminating pregnancy if the gestational age is less than 12 weeks. Most women succeed in aborting their pregnancy at home if they use abortive drugs in a proper dosage regime without having to visit a doctor,  hospital or clinic. However, some cases may need to visit the doctor at a later stage after the abortion to perform some tests and ensure that the pregnancy is terminated completely (i.e. there are no residues inside the uterus). Misoprostol (the active ingredient in Misoprost) is one of the most common drugs in the Middle East and North Africa, which is used to terminate early pregnancy (when the gestational age is less than 12 weeks). Most women prefer the use of abortive drugs to avoid surgical complications and because medical abortion gives them more privacy and safety.

Contraindications

You should not use Misoprost to terminate early pregnancy, if any of the following applies to you:

  1. If your pregnancy is less than 5 weeks or older than 12 weeks.
  2. If your pregnancy is ectopic: ectopic pregnancy is rare, and can be excluded by ultrasound. If your pregnancy is ectopic, the doctor will terminate the pregnancy surgically, even in the countries that restrict abortion(surgical abortion is a must in ectopic pregnancy).
  3. If you use the IUD as a contraceptive (the IUD is a device placed in the uterus for contraception purpose). The IUD must be removed before using any abortive medicines.
  4. If you have had a caesarean section in the last year, have undergone surgery in the womb or major surgery within the last year.
  5. Sensitivity to the active substance (which is rare, 8 out of 1000 might experience sensitivity reactions with Misoprostol).
misoprost tablet is misoprostol product by CID for multipharm)
misoprost tablet is misoprostol product by CID for multipharm)

Dosage and method of administration

For prevention of stomach ulcer associated with NSAID

The recommended oral dose of Misoprost to prevent the effects of analgesics is 200 micrograms four times daily during the NSAID treatment. The Misoprost pill should be taken with a meal, and the last dose should be at bedtime. If a 200 μg dose can not be tolerated, a dose of 100 μg can be used.

For Early Medical Abortion- recommended by WHO

If your gestational age is less than 12 weeks (84 days), you need at least 12 tablets of Misoprost. The WHO (World Health Organization ) recommend using  800 micrograms of Misoprostol taken by vagina or sublingual. With a maximum of three repeated doses at intervals of not less than 3 hours and not more than 12 hours (i.e.  4 tablets inserted into the vagina or placed under the tongue, every 3 hours, repeated three times).

Example for the WHO proposed dosage system for early abortion using Misoprostol only, when the gestational age is less than 12 weeks (84 days)

❶ 10 am dose: Place 4 tablets of Misoprost under the tongue and leave them in the mouth cavity for 30 minutes. You can also use the 4 pills through the vagina, by inserting them deep into the vaginal canal, one after the other, using the finger or vaginal applicator device.

1 pm dose: Repeat the same dose (4 pills) under the tongue or vagina. You should use the same method every time. If you start the first dose by taking the pills by mouth, then the other doses will be taken orally. Do not take Misoprostol pills in a different way each time.

4 pm dose: Repeat the same dosage (4 pills) under the tongue, or in the vagina. Make sure to follow the same method you used in the previous two doses.

Reference: WHO guideline book.

For Early Medical Abortion- recommended by Obstetricians and gynecologists

Obstetricians and gynecologists, in Egypt, recommend a dose regime different from the WHO recommended dosage system.  This dosage regime has been proven effective. This method is based on the use of only 10 tablets of Misoprost. The following is an explanation of the method often recommended by gynecologists and obstetricians:

① The first dose (2 vaginal tablets, 2 oral tablets): 2 tablet placed in the oral cavity / sublingual (left to dissolve for 30 minutes, then swallow any remains with an appropriate amount of water). At the same time, the woman inserts 2 tablets into the vagina (one tablet at a time) and stays on your back for half an hour.

② Second dose (2 tablets orally only after 3 hours of the first dose): 2 tablets placed in the oral cavity / sublingual (left to dissolve for 30 minutes, then swallow any remains with an appropriate amount of water).

③ Third dose (2 tablets orally only after 3 hours of the second dose): 2 tablet placed in the oral cavity / sublingual (left to dissolve for 30 minutes, then swallow any remains with an appropriate amount of water).

④ The fourth dose (2 tablets orally only after 3 hours of the third dose): 2 tablet placed in the oral cavity / sublingual (left to dissolve for 30 minutes, then swallow any remains with an appropriate amount of water).

Side effects

If you take Misoprost to end your early pregnancy with a proper dose regime, it is not expected to experience severe or serious side effects. the following are the undesirable effects  associated with Misoprost:

After taking Misoprost, you may feel chills, fever , sweating, diarrhea and headache. And there is no need to do anything. These side effects  are affordable and will disappear over time.

The cramps / pain in the lower abdomin that accompany the Misoprost pills are evidence that the drug works. you can take an analgesic to ease your pain.

Bleeding is a sign of the onset of abortion or termination of pregnancy and is often heavier than menstrual bleeding with lumps and blood clotting (the volume of bleeding is proportional to the gestational age, the older the pregnancy, the heavier the bleeding).

Complications

In countries that prevent abortion, you do not have to tell the medical team that you tried to have an abortion. You can claim that you have had an involuntary abortion as a result of lifting something heavy or or something like that.  there is no examination that may reveal that you have been used Misoprostol pills.

One out of 10 women, who use Misoprostol pills (e.g. Misoprost), may experience medical complications or serious problems requiring hospitalization .

Severe bleeding, incomplete abortion and abortion Failure are the most common medical complication that might associated with Misoprost.

How do I get Misotac in Egypt

Click the next link, you will be redirected to another page(Egypt- Safe abortion Pill and non-judgmental support), at (How do I get the abortion pills) section.

Patient Information leaflet

Misoprost: patient information leaflet/ arabic.

Misoprost: Patient information leaflet/ english.

Related articles

  1. Abortion Pills in Egypt.
  2. Cytotec tablets- Misoprostol in Egypt.
  3. Safe early medical abortion in Egypt.
  4. Egypt: access to safe abortion procedure.
  5. Misoprostol guidelines

Disclaimer: Some women choose to terminate their pregnancies early for various reasons, we believe that all women anywhere, have the right to have safe abortion options, and we work to provide facts and information related to abortion drugs such as what should be taken into account in advance before using drugs How to get high-quality abortion pills, how to use them safely, what you can expect and when to seek medical help when needed. Our mission is to educate women about the information needed to pass the process of early termination of pregnancy safely and securely. We have made every effort to ensure the accuracy of the information on this page, but this content is subject to change from time to time, and the authors of the site will not accept any responsibility for the accuracy of the information provided at any time. Ref: A02BB01 .

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