Misoprostol for Pregnancy Failure: A Summary of Progress - from Research to Reality

Beverly Winikoff , MD, MPH, Gynuity Health Projects

Over the past decade, misoprostol, an inexpensive prostaglandin E1 analog that can be stored at room temperature, has been found to have multiple potential uses in obstetrics and gynecology. Among the uses that is now almost ready for prime time is its use to provide a medical alternative to surgical treatment for early pregnancy failure. Such a regimen is especially appealing for use in parts of the world where surgery is either unsafe or not feasible to provide. This presentation reviews the process of creating an acceptable regimen for the use of this drug, from dose finding to randomized controlled trials comparing misoprostol to surgical alternatives and to expectant management.  The method shows high success and acceptability to women for all categories of early pregnancy failure. It is appropriate to contemplate modalities of making this method more widely known and available. The chances of wide adoption of the method would be enhanced if a pharmaceutical company were willing to register and market the method. The presentation will suggest pathways to use of the method with and without a dedicated product on the market.