How does misoprostol, the medicine recommended by the WHO for the voluntary termination of pregnancy, work?

In Argentina, abortion is legal in a series of cases determined on an ad hoc basis. But there are countries where the practice is allowed to interrupt an unwanted pregnancy. In all these circumstances, the World Health Organization (WHO) has a drug of choice for medical abortion: misoprostol.

It's a Analogue of prostaglandin E1 which, like natural prostaglandins, acts on several tissues, including the gastric mucosa and smooth muscle of the uterus and cervix of the uterus. It causes contractions of the smooth muscle of the uterus, stimulates cervical ripening and increases uterine tone.

At the beginning, this drug has been designed and marketed for the treatment of gastropathy by NSAIDs, Ie gastric and duodenal ulcers, particularly those resulting from prolonged use of nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen or aceclofenac. But currently, it is widely accepted and used for other indications.

In March 2005, The WHO has included it in its list of essential drugs, having demonstrated its efficacy and safety profile for the treatment of incomplete abortion and spontaneous abortion. Indications include: cervical ripening, abortion initiation in the first and second trimesters, prevention and prophylaxis of postpartum haemorrhage, incomplete abortion, instrumental preparation of the cervix (WHO, 2005).

In Argentina, until the end of 2014, the National Administration of Medicines, Food and Medical Technologies (ANMAT) had not approved these indications. However, in many countries, medicines may be used in a manner and for indications that are not included in the original registration. This use, called off label or "off label", is a fairly common and accepted practice.

For example, by the US Food and Drug Administration (FDA), which states in this regard: "Good medical practice and the best interests of patients require that doctors use drugs […] legally available according to their knowledge and best judgment. If a physician uses a drug that has a different indication than the one for which the drug was approved, he or she must be very knowledgeable about the product and base its use on firm medical reasoning and sound scientific evidence, in addition to maintaining a file. of the use of the product and its effects ".

At the local level, ANMAT has authorized, through provision 946/2018, the sale in pharmacies, by archived prescription, of the drug, which can be acquired for the first time when doctors consider that the woman is under one of the circumstances provided by the legal interruption of pregnancy (ILE).

Its use in the voluntary termination of pregnancy

The procedure of terminating pregnancy with medication has proved acceptable in many settings, even in low-income countries. The drug of choice recommended by WHO is misoprostol in combination with mifepristone, the latter being dramatically increases the effectiveness of treatment, decreases response time and pain. However, mifepristone is not available in all countries and, in these cases, misoprostol-based regimens are generally used.

The effectors for health must have an aspiration or a possibility of reference to be used in case of failure or incomplete abortion.

In the country, the aforementioned protocol suggests widespread practice and many surveys have shown that The completion of the outpatient procedure is a safe and effective option. In addition, many women choose it because it allows them to begin the process of disruption at the most comfortable time and gives them greater peace of mind.

In order for the woman to perform the home intervention, it is essential that the caregiver team:

-Brinde the previous advice so that the woman can decide to do it this way.

– Guarantee the woman the medications necessary for the procedure, including painkillers, in case she needs them.

– Complete all administrative requirements: medical history, informed consent and affidavit in case of violation.

-Corrobore, you understand the slogans and the alarm guidelines.

– Evaluate that you do not have any other pathologies that could put your health in danger.

-According to follow-up visits after the procedure.

Once it is established that it is possible to perform home treatment and that the woman accepts this option, it must be explained to him how to do it, by providing clear and precise information about it. what to expect regarding badl bleeding and expulsion of the product. of conception, and how to recognize complications.

It is important to inform the woman of the expected effects, especially in cases where she is performing outpatient treatment, to reduce the worries that may result when she is at home. These include:

– Bleeding: It usually starts the day the medication is taken. It is mild to moderate, lasts an average of 9 days but can last until the next menstrual period.

– Abdominal pain or cramps: they usually start in the hour after taking misoprostol. To reduce them, painkillers, such as ibuprofen, can be taken.

– gastrointestinal symptoms: Diarrhea, nausea and vomiting may occur.

– Fever / chills: Sometimes they happen and are pbadengers, it is usually a mild fever and gives way to the usual doses of NSAIDs.

It is estimated that the success rate with the misoprostol regimen to achieve complete abortion is close to 90%, regardless of whether it is used during pregnancy in the first or second trimester of pregnancy (FLASOG, 2013). The effectiveness is superior if the mifepristone + misoprostol regimen is used.

It is important to emphasize that the result will depend on the time of waiting to achieve the desired effect. Then then the abortion rate in the first 24 hours is greater than 80% and increases with timeuntil about 72 hours after administration.

In most cases, fetal and placental expulsion occurs within the first 24 hours, but can last between 48 and 72 hours (FLASOG, 2013).

The administration of this drug should be indicated by a doctor, who will also be responsible for guiding its use and monitoring the patient.