Misoprostol for PAC

Nuriye Nalan Sahin Hodoglugil, MD, MA, DrPHAssociate Medical Director

nuriye@venturestrategies.org

Integration of misoprostol into PAC services• Very effective, safe, first line of treatment• Integration into training manuals and documents

for PAC• MVA and misoprostol offered together • Registration of misoprostol for incomplete

abortion and miscarriage

Misoprostol for PAC in Sudan• Challenges with the registration (for treatment

and prevention of PPH)• Current use: well accepted by OB/GYNs• Future use:

– Pilot study to compare MVA with PAC– DKT trainings for MVA including misoprostol;

integrated into the documents approved by a technical committee of MOH

Registration of Misoprostol in Africa & Asia

*Misoprostol may or may not be registered for gastric ulcers

Registered for gastric ulcers only

Registered for postpartum hemorrhage (PPH)*

Registered for PPH and another ob/gyn indication*

Registered for other ob/gyn indication (not PPH)*

NEPAL

INDIA

TANZANIANIGERIA BANGLADESH

ZAMBIA

UGANDA

SUDAN

GHANA KENYA

SOMALILAND

MOZAMBIQUE

Integrated CAC (Comprehensive Abortion Care) ModelServices by Level of Care

Health Post

Health Center

Hospital

Distribute contraceptives Refer for safe abortion & post-abortion services Provide pain medication Medication Abortion: = < 9 weeks gestation, * = < 12 weeks gestation * *

MVA < 12 weeks gestation Treatment of incomplete abortion < 12 weeks with misoprostol Treatment of incomplete abortion < 12 weeks with MVA Administer antibiotics and IV fluids Second trimester uterine evacuation (abortion, IUFD, incomplete abortion) Treatment of complications

PAC as a Women’s Right Issue:

Excerpt from the United Nations Fourth World Conference on Women (Beijing, China - September 1995)

• “In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counseling, education and family-planning services should be offered promptly, which will also help to avoid repeat abortions", consider reviewing laws containing punitive measures against women who have undergone illegal abortions…”

Thank you!