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Knowledge of correct misoprostol dosage labour
induction, uterine evacuation and PPH insufficient.
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| Article Type: | Clinical report |
| Subject: |
Misoprostol
(Dosage and administration) Misoprostol (Research) Medical personnel (Surveys) Practice guidelines (Medicine) (Usage) Off-label prescribing (Standards) Off-label prescribing (Research) |
| Pub Date: | 05/01/2010 |
| Publication: | Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080 |
| Issue: | Date: May, 2010 Source Volume: 18 Source Issue: 35 |
| Topic: | Event Code: 310 Science & research; 350 Product standards, safety, & recalls |
| Product: | Product Code: 8010000 Medical Personnel NAICS Code: 62 Health Care and Social Assistance |
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| Accession Number: | 236247750 |
| Full Text: |
Misoprostol is effective for labour induction, uterine evacuation,
and prevention and treatment of post-partum haemorrhage although it is
used off-label for these indications in most countries. Dosage regimens
vary by indication, gestation, and route of administration so there is
potential for the dangerous use of incorrect doses. This study aimed to
identify the dosage regimens used by a sample of clinicians worldwide
and to compare it with the dosages recommended by a WHO-convened expert
group in Bellagio in 2007. An online survey using the SurveyMonkey tool
was sent to all clinicians working in reproductive health known by the
authors, between May and October 2008. Respondents were asked to
complete the survey and forward it to other suitable clinicians. The
survey was also advertised in relevant newsletters. 211 clinicians
completed the full survey: 46% from Canada, 14% from the US, 17% from
the UK, 5% from Brazil, 5% from Uganda, 3% from India, and 10% from
other countries. 65% worked mainly in public hospitals, 8% in private
hospitals, and the rest in academic institutions. 92% were specialists
in obstetrics and gynaecology and the rest were non-specialists. 49%
listed their hospital protocol or guidelines as the source of dosage
information. Although most practitioners used appropriate dosages of
misoprostol in the first trimester and for induction of labour at term,
there was a considerable difference in dosages used for other
indications--particularly for intrauterine fetal death. 63% and 60% of
clinicians used initial doses that were higher than recommended for
second and third-trimester fetal death, respectively, despite the fact
that 77% of respondents were from the US, Canada, or the UK--where there
is easy access to guidelines. Clinicians consider the risks to be lower
with induction for fetal death, and it is true that less fetal
supervision is needed. However, there is increased risk of uterine
rupture and doses should not be higher than those used for labour
induction with a live infant. There is an urgent need to disseminate
international evidence-based guidelines. The recent decision by FIGO to
adopt anal publicise the Bellagio guidelines will contribute to the
safer use of misoprostol. (1) (1.) Deole N, Weeks A. Knowledge of correct dosages of misoprostol in reproductive health. International Journal of Gynecology and Obstetrics 2010;109:71-77. |
| Gale Copyright: | Copyright 2010 Gale, Cengage Learning. All rights reserved. |
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