New guidance on second-trimester postabortion care

Ipas recently conducted a systematic review
to search for clinical guidance on treating women who present in the
second trimester with incomplete abortion or fetal demise (sometimes
known as postabortion care).  The review found that misoprostol with or
without mifepristone is an effective treatment.

For more information and clinical care guidelines, read the review article in the International Journal of Gynecology & Obstetrics. For guidance on second-trimester postabortion care and other topics, see Ipas’s Clinical Updates in Reproductive Health.

Recommendations for second-trimester postabortion care:

The following recommendations are made on good and consistent scientific evidence (Grade A):

• Misoprostol should be used in preference to oxytocin alone.
• Vaginal or sublingual administration of misoprostol is superior to oral administration.

The following recommendations are made on limited or inconsistent scientific evidence (Grade B):

• Misoprostol should be given at a dose of at least 200 μg.
• The frequency of misoprostol dosing should be at least every 6 hours.
• When available and time permitting, mifepristone should be used before misoprostol.
• Osmotic dilators should not be used.

The following recommendations are based primarily on expert opinion (Grade C):

• Buccal administration of misoprostol can be used.

For more information, contact [email protected]