Wye Yee Herbert


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    Our love affair with misoprostol over the last
    20 years
    Herbert, WY
    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
    complication rates.
    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%.