Misoprostol: A Life-Saving Technology

Jennifer Blum, MPH

Setting the Stage Misoprostol is an orally administered prostaglandin It is inexpensive (< $0.35), off-patent, easy to store (cold chain

not needed), easy to administer/“no touch” & widely available Can use for a range of RH conditions Both new and generic products: New products for abortion in

France/EU & labor induction in Egypt & Brazil. Generics now in India, China, Egypt, Vietnam and Korea among others…

Can be given at all levels of health care system; by mid & low level providers

Where there high medical personnel turnover, misoprostol can be quickly learned and safely used

Added to WHO Model List of Essential Drugs for medical abortion with mifepristone and also for labor induction (at 25 mcg)

Not listed for PPH indication – no product registered for this indication so none for WHO to review

Recommended RegimensPPH Prevention

Recommended dose/route: Single dose of 600 mcg orally to be swallowed after delivery of the baby

PPH Treatment

Recommended dose/route: Limited data available on specific dose and route for PPH treatment at this time

• Data available June 2008 suggest 800 mcg sublingually for primary PPH• Studies ongoing of 600 mcg sublingually as adjunct PPH treatment

Incomplete Abortion (PAC)

Dose/Route: In women with uterine size ≥12 wks LMP at presentation for care with open cervical os, a single dose of either 600 mcg orally or 400 mcg sublingually

Misoprostol for PPH Prevention: WHO Recommendations

• If AMTSL and skilled attendant, oxytocin (10 IU IM) is preferred over oral misoprostol (600 mcg) and ergometrine for PPH prevention

• If no AMTSL, a uterotonic drug (oxytocin or misoprostol) should be offered by a health worker trained in its use for prevention of PPH

Possible Inclusion in Crises Settings

Misoprostol can be included in Interagency Emergency Health Kit or Interagency RH Kits for both PPH and PAC services

Misoprostol should be added to Core Package of RH Interventions recommended by IAWG

No data from web survey on evidence of misoprostol use for RH in relief settings – antidotal evidence suggests that use is ad hoc and on provider basis

Barriers to Use No misoprostol product registered for either PPH or

PAC

Limited marketing of misoprostol by Phizer in sub-Saharan Africa; limited formal distribution as well

Several countries have now “approved use” of misoprostol for PPH, e.g. India, Nigeria…

In many places, providers are not allowed to procure or use a drug for an “off-label” indication

No operations research studies, yet, to show potential use and create model of use of misoprostol in relief settings

Potential Benefits for Use in Relief Settings

Could reduce maternal morbidity and mortality associated with PPH prevention and treatment of unsafe abortion

Will empower women and providers by giving them a treatment option not previously available

Health care systems will benefit – doctors workloads and the cost of surgical care, IV infusions and referrals will be reduced

Thank you!

Any questions?

Session 3 Brainstorm and voting1. Speakers plot their technology on

continuum.2. Assemble in 3 groups by row.3. Each group identify 1 technology currently

in an RH kit but still underutilized.4. Each group identify 1-2 technologies NOT

currently in a kit but needed.5. Each group presents and plots their

technologies on the continuum.6. Each participant has 3 votes to prioritize

technologies identified on the continuum during coffee and tea break.