The ideal dosing regimen for second-trimester procedures is unknown. In terms of safety, a review of more than 6000 surgical abortions between 12 and 16 weeks using 400 µg of vaginal or buccal misoprostol 90 minutes preprocedure showed a uterine perforation rate of 0.45 per 1000, comparable to historical reports for laminaria use.49… Read more

Medication abortion necessarily involves heavy bleeding and cramping as the pregnancy is expelled. Other transient side effects from misoprostol include nausea, vomiting, diarrhea, fever, and chills.21 At the follow-up visit, ongoing pregnancies are most commonly treated with suction curettage because of the risk of congenital anomalies.… Read more

Based on a single, small study, IUD insertion in nulliparous women may be facilitated by misoprostol use. A Swedish trial randomized 80 women to 400 µg of sublingual misoprostol plus 100 mg of diclofenac or 100 mg of diclofenac alone 1 hour before Nova-T IUD insertion.65 Although baseline cervical dilation was similar in both groups,… Read more

Candidates for medication abortion must be able to adhere to the treatment regimen as well as have access to a telephone and transportation to a medical facility in case of emergency. Multiple gestation is not a contraindication to medication abortion provided that the pregnancy is no more than 49 to 63 days, depending on the regimen being… Read more

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Only a single study has evaluated misoprostol for endometrial biopsy. This trial randomized a mixed population of 42 premenopausal, perimenopausal, and postmenopausal women to either 400 µg of oral misoprostol or placebo 3 hours prior to endometrial biopsy.64 This study found no evidence of an effect on cervical resistance, success rate… Read more

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The optimal dosing regimen for cervical ripening before hysteroscopy is unclear. In premenopausal women, studies have found either 200, 400, or 1000 µg of vaginal misoprostol or 400 µg of oral misoprostol given at least 9 to 12 hours preoperatively to be superior to placebo.53–57 Most of these studies focused on nulliparous women. There are… Read more

Researchers have studied cervical ripening prior to other gynecologic procedures in nonpregnant women, including hysteroscopy, endometrial biopsy, and intrauterine device (IUD) insertion. Similar to cervical ripening prior to surgical abortion, the aim of misoprostol use in hysteroscopy is to prevent complications of mechanical dilation such… Read more

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