Abortion
Misoprostol is used either alone or in conjunction with another medication (mifepristone or methotrexate) for medical abortions as an alternative to surgical abortion.[22] Medical abortion has the advantage of being less invasive, and more autonomous, self-directed, and discreet. It is preferred by some women because it feels more "natural," as the drugs induce a miscarriage.[23] It is also more easily accessible in places where abortion is illegal.[24] The World Health Organization provides clear guidelines on the use, benefits and risks of misoprostol for abortions.[25]
Misoprostol is most effective when it is used in combination with methotrexate or mifepristone (RU-486).[26] Mifepristone inhibits the signals of pregnancy hormones, eventually causing the uterine lining to degrade, similar to a period, which cause the embryo to detach from the uterus walls.[citation needed] Misoprostol then dilates the cervix and induces muscle contractions which clear the uterus.[citation needed] Misoprostol alone is less effective (typically 88% up to eight-weeks gestation). It is not inherently unsafe if medically supervised, but 1% of women will have heavy bleeding requiring medical attention, some women may have ectopic pregnancy, and the 12% of pregnancies that continue after misoprostol failure are more likely to have birth defects and are usually followed up with a more effective method of abortion.[27]
Most large studies recommend a protocol for the use of misoprostol in combination with mifepristone.[28] Together they are effective in around 95% for early pregnancies.[29] Misoprostol alone may be more effective in earlier gestation.[30] WHO guidelines recommend for pregnancies up to 12 weeks to use 12 tablets of 200 mcg (micrograms). The pregnant person should put 4 tablets of misoprostol under the tongue or far up the vagina and let them dissolve for 30 minutes. The pregnant person should wait 3 hours and repeat with 4 pills under the tongue or in the vagina for 30 minutes. The pregnant person should wait 3 hours and repeat once more.[26] It works in 90% after first attempt and, in case of failure, the attempt may be repeated after a minimum of 3 days.
Misoprostol can also be used to dilate the cervix in preparation for a surgical abortion, particularly in the second trimester (either alone or in combination with laminaria stents). Vaginal misoprostol can also be used to facilitate intrauterine device insertion after previous insertion failure.[31]
Misoprostol by mouth is the least effective treatment for producing complete abortion in a period of 24 hours due to the liver's first-pass effect which reduces the bioavailability of the misoprostol. Vaginal and sublingual routes result in greater efficacy and extended duration of action because these routes of administration allow the drug to be directly absorbed into circulation by bypassing the liver first-pass effect.[32][33]
The following tests are recommended before use for abortion confirmation of pregnancy, hematocrit or Hb tests, and Rh testing.[34] Following use, it is recommended that people attend a follow-up visit 2 weeks after treatment. If used for treatment of complete abortion, a pregnancy test, physical examination of the uterus, and ultrasound should be performed to ensure success of treatment. Surgical management is possible in the case of failed treatment.[32]
https://en.wikipedia.org/wiki/Misoprostol#Abortion