Knowledge of correct misoprostol dosage labour induction, uterine evacuation and PPH insufficient.
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
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.
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