Our love affair with misoprostol over the last
The Queen Elizabeth Hospital Pregnancy Advisory Centre, Australia
TheQueen Elizabeth Hospital Pregnancy Advisory Centre in
Adelaide, South Australia is agovernment-funded clinic established
in 1992,providing over 2500 surgical terminations eachyear.
Four papers published over the last 20 years document our
implementation of misoprostol use, showing signiﬁcant
improvements in service delivery, as well as reduction in
Our ﬁrst study published in 1999 showed that adding
misoprostol to osmotic dilators at 17–20 weeks of gestation to
increase passive dilatation of the cervix, markedly reduces the risk
of perforation of the uterus.
Our second study published in 2009 compared the outcomes
of four different peri-operative misoprostol regimens for ﬁrst
trimester surgical terminations. Compared to no misoprostol
regimen, the regimen of 200 lg of oral misoprostol 3 hours
pre-operatively plus 200 lg of misoprostol vaginally at the end of
the surgical procedure showed: 90% reduction in difﬁcult cervical
dilatations, 60% reduction in rate of D&C treatment of retained
products of conception and 71% reduction in incidence of
women requiring post-operative contact for concerns.
In 2011, our third study demonstrated that adding 200 lg of
oral misoprostol 3 hours before two tablets sublingually every
half-hour for three doses at 13–16 weeks of gestation further
reduced difﬁculty of the operation.
In 2002, we adopted medical management with misoprostol,
as ﬁrst-line treatment for retained products following surgical
termination. Our study published in 2009 showed that the
regimen of 200 lg of misoprostol orally or sublingually three
times a day for six doses was 93% effective, and reduced the
D&C rate by 79.6% from 1.18% to 0.24%.