Cervical priming
(prior to hysteroscopy, surgical uterine evacuation, intrauterine device insertion)
The full guidance on the cervical priming has been published in the International Journal of Gynecology and Obstetrics 2007;99(supp 2):S168-71, and is available as a read-only pfd file here.
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Recommended Dosage 400mcg vaginally or sublingually 3 hours before the procedure |
400 mg misoprostol given vaginally or sublingually 3h prior to the procedure.
The 3 hours waiting period from administration to the procedure needs to be integrated in the treatment course. The drug may be administered by the women herself before she comes to the health facility. Patients should be advised that the treatment might lead to cramps and/or bleeding within minutes of administration. Pain treatment should always be offered. Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen and Naproxen do not impair the efficacy of misoprostol for cervical priming.
When used for abortion, expulsion may occur in some cases before surgery is performed. The probability of expulsion increases with the interval from administration of misoprostol to the procedure and in cases of missed abortion.
With sublingual administration the tablets should be kept under the tongue until dissolved or at least for 20 minutes and then swallowed.
These recommendations are produced by an expert group on misoprostol brought together by WHO in Bellagio, Italy in Feb 2007. These recommendations do not reflect official WHO guidelines, but have been released early so as to provide guidance to clinicians worldwide. The excerpt above is taken from:
International Journal of Gynecology and Obstetrics 2007;99(supp 2):S168-71.
Alternative guidelines for cervical priming are available here.