Cervical ripening pre-instrumentation

The full guidance on missed abortion has been published in the International Journal of Gynecology and Obstetrics 2007;99(supp 2):S168-71, and is available as a read-only pdf file here.

Recommended Dosages

400mcg vaginally 3-hrs or sublingually 2-3 hrs before procedure


Course of Treatment

The 3 h waiting period from administration to the procedure needs to be integrated in the treatment course. The drug may be administered by the woman 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.

Side effects
Expected side effects are bleeding and uterine contractions. The contractions may necessitate pain treatment. The woman should be informed of where to seek help if needed. Other side effects are rare and fully reversible. The following symptoms may occur: diarrhoea, shivering, nausea, vomiting, increased body temperature and skin rash. Some patients report an unpleasant taste of the misoprostol tablets or a short lasting numbness of the tongue if taken sublingually.

These recommendations are produced by an expert group on misoprostol brought together by WHO in Bellagio, Italy in Feb 2007. The excerpt above is taken from: Fiala C, Gemzell-Danielsson K, Tang OS, von Hertzen H. Cervical priming with misoprostol prior to transcervical procedures. International Journal of Gynecology and Obstetrics 2007;99(supp 2):S168-71.

A detailed document on this topic can be viewed here