ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -16 مورد

Society protocols for medication management of second-trimester pregnancy loss*

Society protocols for medication management of second-trimester pregnancy loss*
Source Sequential mifepristone and misoprostol (preferred) Misoprostol monotherapy
(alternative if mifepristone is unavailable)
Mifepristone dosing and administration Interval between mifepristone and first dose of misoprostol Misoprostol dosing and administration
American College of Obstetricians and Gynecologists[1], endorsed by the Society of Family Planning and the Society of Maternal-Fetal Medicine 200 mg orally (single dose) 24 to 48 hours

800 mcg PV, followed by 400 mcg PV/SL every 3 hours as needed

or

400 mcg buccally every 3 hours as needed

Maximum number of doses: 5Δ

400 mcg PV/SL every 3 hours as needed

or

600-800 mcg PV loading dose followed by 400 mcg PV/SL every 3 hours as needed

Maximum number of doses: 5Δ
World Health Organization[2] 200 mg orally (single dose) 24 to 48 hours 400 mcg BU/SL/PV every 3 hours as needed 400 mcg PV/SL/BU every 3 hours as needed
International Federation of Gynecology and Obstetrics (FIGO)[3] 200 mg orally (single dose) 24 to 48 hours 400 mcg every 3 hours BU/SL/PV until expulsion◊[3,4] 400 mcg BU/SL every 3 hours as needed◊[3]
Medication management of second-trimester (13+0 to 19+6 weeks of gestation) pregnancy loss generally involves a single dose of mifepristone followed 24 to 48 hours later by repeated doses of misoprostol to induce passage of uterine contents. Regimens provided are extrapolated from society guidelines for second-trimester termination. For additional information, refer to the clinical topic reviews on pregnancy loss.

BU: buccal; PO: per oral; PV: intravaginal; SL: sublingual.

* For purposes of this content, second trimester ranges from 13 weeks to 19 6/7 weeks gestation.

¶ Shorter (eg, simultaneous dosing or dosing before 24 hours) and longer (eg, 48 hours initial dose) intervals are reasonable based onpatient circumstances.

Δ Based on medication abortion, if the pregnancy loss is not complete after 5 doses of misoprostol, the patient may rest for 12 hours and then repeat the cycle again.[1]

◊ Based on medication abortion, if the pregnancy loss is not complete after 5 doses, the patient may receive additional doses or rest for 12 hours followed by additional doses.[3]
References:
  1. ACOG Practice Bulletin No. 135: Second-trimester abortion. Obstet Gynecol 2013; 121:1394. Reaffirmed 2017.
  2. Abortion care guideline. Geneva: World Health Organization; 2022.
  3. FIGO Mifepristone & Misoprostol and Misoprostol Only Dosing Charts 2023. International Federation of Gynecology and Obstetrics (FIGO). Available at: https://www.figo.org/figo-mifepristone-misoprostol-and-misoprostol-only-dosing-charts-2023 (Accessed on September 10, 2024).
  4. Zwerling B, Edelman A, Jackson A, et al. Society of Family Planning Clinical Recommendation: Medication abortion between 14 0/7 and 27 6/7 weeks of gestation. Contraception 2023; 110143.

Courtesy of Sarah Prager, MD, MAS; Elizabeth Micks, MD, MPH; and Vanessa K Dalton, MD, MPH.

Graphic 127047 Version 3.0