Sito in Italia dove è possibile acquistare la consegna acquisto Viagra a buon mercato e di alta qualità in ogni parte del mondo.
International Journal of Gynecology and Obstetrics (2007) 99, S172–S177
a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m
w w w . e l s e v i e r. c o m / l o c a t e / i j g o
Misoprostol for the termination of pregnancy up to 12completed weeks of pregnancy
A. Faúndes a,⁎, C. Fiala b, O.S. Tang c, A. Velasco d
a Department of Gynecology and Obstetrics, State University of Campinas (UNICAMP), Campinas, SP, Brazilb Gynmed Clinic, Vienna, Austriac Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong SAR, Chinad Department of Gynecology and Obstetrics. Hospital Eusebio Hernández (Maternidad Obrera), Havana, Cuba
The aim was to review the current knowledge about the use of misoprostol alone for abortioninduction during the first 12 weeks of pregnancy. Publications reporting experiences withmisoprostol alone for pregnancy termination within the first 12 weeks of pregnancy were included
in the analysis. Vaginal administration of 800 μg repeated up to three times at 6, 12 or 24 h intervals
has an 85% to 90% effectiveness, defined as complete abortion, in most studies. Oral administration
is less effective, but sublingual administration at 3-hour interval has the same effectiveness, with
more frequent side effects. The oral and sublingual routes appear to be better accepted thanvaginal administration. Most studies are limited to the first 9 weeks of pregnancy. The experience onpregnancy termination between 10 and 12 weeks is not yet sufficient for a recommendation.
2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd.
All rights reserved.
The regimen of mifepristone followed by a suitableprostaglandin analogue (usually misoprostol) has become
It is estimated that 46 million pregnancies are terminated
increasingly available and is now the gold standard for
voluntarily each year, 27 million carried out under safe
conditions and 19 million falling into the category of “unsafeabortions” Until the second half of the twentieth century,
Mifepristone is an antiprogestin that blocks most proges-
dilatation and curettage (D & C) was the most common and
terone receptors. When a prostaglandin is administered 24 to
virtually only method used for safe termination of early
48 h after mifepristone, uterine contractions expel the
pregnancy. Abortion by vacuum aspiration gained greater
products of conception and the effectiveness of the
acceptance in the 1960s and has become the standard of care.
combination is greatly enhanced. This medical abortion
First trimester pregnancy can also be terminated safely
regimen is highly effective and well accepted and
pharmacologically (medical abortion).
women who wish to avoid invasive procedures regardmedical abortion as a more natural and preferable option. The combination of metrotrexate and misoprostol hasalso been used, but this combination has not proven
⁎ Corresponding author. Tel.: +55 19 3289 2856; fax: +55 19 3289 2440.
0020-7292/$ - see front matter 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd.
All rights reserved.
Misoprostol for the termination of pregnancy up to 12 completed weeks of pregnancy
Where mifepristone is not accessible, various misoprostol-
Recently, the buccal route of administration has also
only regimens are being used, and dozens of reports have
been investigated, but not yet for this indication
been published on the outcomes of various treatments. The
Intervals between doses vary from 3 to 48 h .
comparison of the results of the published data on the use of
According to pharmacokinetics and clinical experience, the
misoprostol is not possible due to a lack of uniformity in many
interval between vaginal doses may not need to be shorter
variables: intervals between doses vary from 3 to 48 h, the
than 5–6 h and probably no longer than 24 h.
time point for assessing this outcome varies from a few daysto several weeks (), and the gestational age of women
There is experience on the use of these regimens up to
differs between reports. These factors make it difficult to
63 days (9 weeks) pregnancy , but too few
conclude what regimen might be the most effective.
reports on the use of misoprostol between 9–13 weeks
Most publications report vaginal administration of multiple
to affirm that these regimens are equally effective
doses of 800 μg of misoprostol (4 tablets of 200 μg) up
to three doses. The available information suggests that effec-tiveness is dose related with doses up to 800 μg if administered
The misoprostol-only regimen has been approved for the
termination of early pregnancy in only one country (Brazil) at thetime of writing (February 2007). However, its widespread use in
When misoprostol is used alone, the oral route is less
countries with restricted abortion laws appears to be associated
effective than vaginal . Vaginal administration
with reduction in maternal morbidity and mortality .
should therefore be chosen unless there are reasons toavoid it. The sublingual route is a reasonable alternative
Alternative routes may be sought as some acceptability
• Suspected ectopic pregnancy or non-diagnosed adnexal mass.
studies, have shown that women prefer a non-vaginal route
Moreover, when given vaginally, fragments of thetablets may remain visible for many hours.
The sublingual route is a reasonable alternative
Although the sublingual route is significantly less effective thanthe vaginal route if misoprostol is administered every 12 h, the
• If molar pregnancy is diagnosed, intrauterine aspiration
effectiveness is similar if administered with a 3-h interval
between doses . The main drawback of the sublingual route
• If there is an intrauterine device (IUD) in place, this should
is that it may cause more frequent gastrointestinal side-effects
be removed before administering misoprostol.
(such as nausea, vomiting, shivering and hyperthermia) than
• Coagulation disorders/currently taking anticoagulants.
vaginal administration . These side effects are dose
• Women should be advised that the treatment can fail and
dependent and last only for a short time.
they should be prepared to terminate the pregnancy by
Summary of studies with vaginal administration of misoprostol alone for first trimester abortion
surgical method, because there have been reports of con-
genital malformations in newborn infants of mothers givenmisoprostol during the first trimester of pregnancy .
Despite the wide range of results from different studies and
• Breastfeeding: Small amounts of misoprostol or its active
different regimens, the success rate, defined as a complete
metabolite may appear in breast milk . There is no in-
abortion, is around 90% during the first trimester of pregnancy
formation on the effects on nursing infants. It is recom-
Success depends on the length of the time interval
mended therefore that breast milk is not given to the infant
between treatment and the assessment of the outcome.
for 4 h after oral administration or 6 h after vaginal miso-prostol administration.
Depending on the regimen used, pregnancy continues in
• Anemia detected at the time of abortion should be treated
4% to 8% of women with gestational age of up to 63 days
without delaying the procedure. The average blood loss
when vaginal misoprostol is used alone ().
during medical abortions may be more than in surgicalabortions .
• Previous cesarean section: there is evidence from one study
that the safety and efficacy of early abortion (up to seven
In the majority of cases, expulsion of the products of
weeks) is unaffected by previous cesarean section .
conception occurs hours after administration: close to 70%
Although extremely rare, uterine rupture in early pregnancy
within the first 12 h around 80% during the first
24 h, 95% within 48 h and further increases until at least 72 hafter the initial dose However there may be a
large variability depending on route, dose and time intervalbetween misoprostol doses.
The first choice is 800 μg administered by the vaginal routeevery 6, 12 or 24 h for a maximum of three doses. Three doses
Prolonged or serious side effects are rare.
of 800 μg at 3-hourly intervals can also be used sublinguallyMoistening the tablets appears to slightly increase plasma
levels but no improvement in the clinical effects has beendemonstrated Doses higher than 800 μg are not
Vaginal bleeding during abortion induced with misoprostol
recommended due to increased side effects .
is generally more intense than regular menstrual bleedingand is usually no different from that which occurs with a
spontaneous abortion Although there may be greatvariations, there is typically menstrual-like or heavier
Several studies carried out in developed and developing coun-
bleeding for the first week and then spotting for an
tries have shown that home administration of misoprostol is ef-
additional week. The mean pre- to post-abortion fall in
fective and safe up to 9 weeks since the last menstrual period.
hemoglobin varies between 0.2 and 1.0 g/dL (
Most of those studies have been done using the combination of
Prolonged and intensive bleeding affects between 1% and
mifepristone and misoprostol and only a few with
10% of women and may necessitate emergency surgical
uterine evacuation, preferably with manual vacuum as-piration. The need for transfusion has been rarely reported
• Voluntary termination of the pregnancy and informed
consent of the woman about her choices and the nature of
• Backup arrangements for surgical abortion.
Cramping usually starts within the first few hours and may
• Dating of gestational age and ruling out ectopic pregnancy
begin as early as 30 min after misoprostol administration. The
pain may be stronger than that experienced during a regular
• If required by national guidelines, blood group and Rhesus
period and can be present in 80%–90% of women Non-
factor should be determined and in cases where women are
steroidal anti-inflammatory drugs (NSAIDs) or other analgesia
Rhesus negative, a dose of anti-D serum should be admin-
can be used for pain relief without affecting the success of the
istered prior to treatment. However, there is currently little
evidence to support that Rhesus factor isoimmunizationoccurs for pregnancies up to 63 days gestation
Where resources are available, and depending on the
Chills are a common side effect of misoprostol but are
clinical situation, the following tests may be useful:
transient. Hyperthermia can be very severe and morecommon with higher doses when the interval between
• Hemoglobin, hematocrit and screening for STDs may also
doses is shorter or with oral or sublingual administration
be provided depending on local prevalence and guidelines.
. Fever does not necessarily indicate infection.
In addition, serological tests to diagnose for syphilis, HIV
An antipyretic can be used for relief of fever, if needed. If
and hepatitis B and C surface antigen may also be used.
fever or chills persist beyond 24 h after taking misoprostol,
Misoprostol for the termination of pregnancy up to 12 completed weeks of pregnancy
Indicators of bleeding in clinical studies of misoprostol alone for first trimester abortion
the woman may have an infection and should seek medical
include excessive bleeding, fever of more than 1 day and
abdominal pain. Antibiotic treatment should be begunimmediately if there is any suspicion of infection, although
it is less frequent after medical than after surgical methodof abortion .
Women should return for follow-up one or two weeks after
About 20% of women report pregnancy-related nausea and
the initial administration of the drug or earlier if they feel the
vomiting before treatment. These symptoms may
need. A good clinical history and bi-manual exam should
increase after misoprostol administration. An anti-emetic
enable the provider to determine the absence of symptoms
can be used if needed, but symptoms will usually resolve
and that the uterus is firm and well involuted. In case of
uncertainty a pregnancy test and ultrasound examination
may be needed to confirm a complete expulsion. The usualurinary pregnancy tests may be positive for up to 4 weeksfollowing the abortion as the pregnancy hormone hCG is
Diarrhea may also occur following administration of misoprostol
Those women who have not aborted within 72 h after the
last dose should be given the option of a second course of
misoprostol treatment or surgical abortion; they should beinformed that their chances of success of the second course
The risk of fetal abnormalities after misoprostol used early in
is around one in three If there is an urgent need to
pregnancy is probably very low but women who do
evacuate the uterus or if the woman is not prepared to
not abort after misoprostol, should have access to surgical
accept a new attempt of treatment with misoprostol, she
abortion, if that is the woman's informed choice. Vacuum
should be offered the alternative surgical abortion. There is
aspiration is the recommended option.
clear evidence that vacuum aspiration is the preferredtechnique: both electric or manual vacuum aspirations are
Women with incomplete abortion should be offered the
Women should be given simple instructions on how to
choice of aspiration evacuation or misoprostol treatment with
recognize any complications that might require medical
600 μg of oral misoprostol if eligible .
Once administration of misoprostol has begun, women must
have easy access to a health professional capable of answeringtheir questions and providing them with assistance or hospital
Women should be informed about immediate return to
care. During the early first trimester, the possibility of ectopic
fertility, contraceptive methods, their characteristics, effec-
tiveness and side effects, including their capacity to protect
Women must be informed that they will have bleeding
against sexually transmitted infections (STIs). After selection
and cramping as described above, and that they can use
of the most appropriate method, that method should be
NSAIDs as required. The symptoms calling for clinical care
tion with vaginal misoprostol before and after 42 days gesta-tion. Hum Reprod 2002;17(12):3079–83.
 Bugalho A, Faúndes A, Jamisse L, Usfa M, Maria E Bique C.
This chapter was developed for a misoprostol expert meeting
Evaluation of the effectiveness of vaginal misprostol to induce
at the Bellagio Study Center in Italy, supported by the
first trimester abortion. Contraception 1996;53:243–6.
Rockefeller Foundation, Ipas, Gynuity Health Projects and
 Norman JE, Thong KJ, Baird DT. Uterine contractility and
the UNDP/UNFPA/WHO/World Bank Special Programme of
induction of abortion in early pregnancy by misoprostol and
Research, Development and Research Training in Human
mifepristone. Lancet Nov 16 1991;338(8777):1233–6.
 Gemzell-Danielsson K, Marions L, Rodríguez A, Spur BW, Wong
PY, Bygdeman M. Comparison between oral and vaginaladministration of misoprostol on uterine contractility. Obstet
 Gemzell-Danielsson K, Bygdeman M, Aronsson A. Studies on
The authors do not have any conflict of interest.
uterine contractility following mifepristone and various routesof misoprostol. Contraception 2006;74:31–5.
 Blanchard K, Shochet T, Coyaji K, Ngoc NTN, Winikoff B.
Misoprostol alone for early abortion: an evaluation of sevenpotential regimens. Contraception 2005;72(2):91–7.
 WHO-World Health Organization. Unsafe abortion- Global and re-
 Tang OS, Miao BY, Lee SWH, Ho PC. Pilot Study on the use of
gional estimates of the incidence of unsafe abortion and associated
repeated doses of sub-lingual misoprostol in termination of
mortality in 2000. 4th edition. WHO; 2004. 82pp. Available in:
pregnancy up to 12 weeks gestation: efficacy and acceptability.
 Arvidsson C, Hellborg M, Gemzell-Danielsson K. Preference and
 Ashok PM, Hamoda H, Nathani F, Flett GMM, Templeton A.
acceptability of oral versus vaginal administration of misopros-
Randomized controlled study comparing oral and vaginal mis-
tol in medical abortion with mifepristone. Eur J Obstet Gynecol
oprostol for cervical priming prior to surgical termination of
Reprod Biol Nov 1 2005;123(1):87–91.
 Aronson A, Helström L, Gemzell-Danielson K. Sublingual
 Honkanen H, Piaggio G, Hertzen H, Bartfai G, Erdenetungalag R,
compared with oral misoprostol for cervical dilatation prior to
Gemzell-Danielsson K, et al. WHO multinational study of three
vacuum aspiration: a randomized comparison. Contraception
misoprostol regimens after mifepristone for early medical
abortion. BJOG Jul 2004;111(7):715–25.
 von Hertzen H, Piaggio G, Huong NTM, Arustamyan K, Cabezas
 Jain JK, Dutton C, Harwood B, Meckstroth KR, Mishell Jr DR. A
E, Gomez M, et al. Misoprostol for termination of early
prospective randomized, double-blinded, placebo-controlled
pregnancy – a randomized multicentre equivalence trial on
trial comparing mifepristone and vaginal misoprostol to vaginal
two routes and two intervals. Geneva: WHO; 2007.
misoprostol alone for elective termination of early pregnancy.
 Ngai SW, Tang OS, Chan YM, Ho PC. Vaginal misoprostol alone
Hum Reprod Jun 2002;17(6):1477–82.
for medical abortion up to 9 weeks of gestation: efficacy and
 Henshaw RC, Naji SA, Russell IT, Templeton AA. Comparison of
acceptability. Hum Reprod 2000;15:1159–62.
medical abortion with surgical vacuum aspiration: women's
 Zieman M, Fong SK, Benowitz NL, Banskter D, Darney PD.
preferences and acceptability of the treatment. BMJ 1993;307:
Absortion kinetics of misoprostol with oral or vaginal adminis-
tration. Obstet Gynecol 1997;90(1):88–92.
 Carbonell JLI, Varela L, Velazco A, Tanda R, Sánchez C. Vaginal
 Meckstroth KR, Whitaker AK, Bertisch S, Goldberg AB, Darney
misoprostol for Carbonell JL. Velazco A, Varela L, Fernández C.
PD. Misoprostol administered by epithelial routes: drug
The use de misoprostol for termination de early pregnancy.
absorption and uterine response. Obstet Gynecol 2006;108(3):
 Carbonell JL, Varela L, Velazco A, Cabezas E, Tanda R, Sanchez C.
 Salakos N, Kountouris A, Botsis D, Rizos D, Gregoriou O, Detsis
Vaginal misoprostol for late first trimester abortion. Contra-
G, et al. First-trimester pregnancy termination with 800 μg of
vaginal misoprostol every 12 h. Eur J Contracep Reprod Health
 Carbonell Esteve JL, Varela L, Velazco A, Tanda R, Cabezas E,
Sanchez C. Early abortion with 800 μg of misoprostol by the
 Carbonell JL, Rodriguez J, Velazco A, Tanda R, Sanchez C,
vaginal route. Contraception 1999;59:219–25.
Barambio S, et al. Oral and vaginal misoprostol 800 microg
 Jain JK, Meckstroth KR, Mishell Jr DR. Early pregnancy
every 8 h for early abortion. Contraception Jun 2003;67(6):
termination with vaginally administered sodium chloride solu-
tion-moistened misprostol tablets: historical comparison with
 Carbonell Esteve L, Varela L, Velazco A, Tanda R, Sanchez C.
mifepristone and oral misoprostol. Am J Obstet Gynecol
Vaginal misoprostol for abortion at 10–13 weeks gestation. Eur J
Contraception and Reprod Health Care 1999;4(1):35–40.
 Jain JK, Meckstroth KR, Park M, Mishell Jr DR. A comparison of
 Faúndes A, Santos LC, Carvalho M, Gras C. Post abortion
Tamoxifen and Misoprostol to Misoprostol alone for early
complications after interruption of preganancy with misopros-
termination of pregnancy. Contraception 1999;60:353–6.
tol. Adv Contracep 1996;12(1):1–9.
 Jain JK, Harwood B, Meckstroth KR, Mishell Jr DR. Early
 Viggiano M, Faúndes A, Borges AL, Viggiano ABF, Souza GR,
pregnancy termination with vaginal Misoprostol combined with
Rebello I. Disponibilidade de misoprostol e complicações de
loperamide and acetominofen prophylaxis. Contraception
aborto provocado em Goiânia. J Bras Ginecol 1996;106(3): 55–61.
 Miller SE, Lehman T, Campbell M, Hemmerling A, Anderson SB,
 Velazco A, Varela L, Tanda R, Sanchez C, Barambio S, Chami S,
Rodríguez H, et al. Misoprostol and declining abortion-realted
et al. Misoprostol for abortion up to 9 weeks' gestation in
morbidity in Santo Domimgo, Dominican Republic: a temporary
adolescents. Eur J Contracept Reprod Health Care Dec 2000;5(4):
association. Br J Obstet Gynaecol 2005;112: 1291–6.
 Briozzo L, Vidiella G, Vidarte B, Ferreiro G, Cuadro JC, Pons JE.
 Zikopoulos KA, Papanikolaou EG, Kalantaridou SN, Tsanadis GD,
El aborto provocado en condiciones de riesgo. Emergente
Plachouras NI, Dalkalitsis NA, et al. Early pregnancy termina-
sanitario en la mortalidad materna en Uruguay. Situación actual
Misoprostol for the termination of pregnancy up to 12 completed weeks of pregnancy
e Iniciativas medicas de protección materna. RMU 2002;18(1):
 Fiala C, Winikoff B, Helstrom L, Hellborg M, Gemzell-Danielsson
K. Acceptability of home-use of misoprostol in medical
 Lichtenberg ES, Grimes DA, Paul M. Abortion complications:
abortion. Contraception Nov 2004;70(5):387–92.
prevention and management. In: Paul M, Lichtenberg ES, Borgatta
 Ravn P, Rasmussen A, Knudsen UB, Kristiansen FV. An outpatient
L, Grimes DA, Stubblefield PG, editors. A clinician's guide to
regimen of combined oral mifepristone 400 mg and misoprostol
medical and surgical abortion. Philadelphia (PA): Churchill
400 μg for first-trimester legal medical abortion. Acta Obstet
Gynecol Scand Nov 2005;84(11):1098–102.
 Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharma-
 Naik K, Kitau M, Setchell ME, Chard T, et al. The incidence of
cokinetic profiles, effects on the uterus and side-effects. Int J
fetomaternal haemorrhage following elective termination of
Gynecol Obstet 2007;99:S160–7 [this issue].
first-trimester pregnancy. Eur J Obstet Gynecol Reprod Biol
 Abdel-Amin H, Villar J, Gülmezoglu AM, Mostafa SA, Youssef AA,
Shkry M, et al. The pharmacokinetics of the prostaglandin E1
 Fiala C, Fux M, Gemzell Danielsson K. Rh-prophylaxis in early
analogue misoprostol in plasma and colostrums after post-
abortion. Acta Obstet Gynecol Scand 2003;82:892–903.
partum oral administration. Eur J Obstet Gynecol Reprod Biol
 Bugalho A, Mocumbi S, Faúndes A, David E. Termination of
pregnancies of b6 weeks gestation with a single dose of
 Holmgren K. Women's evaluation of three early abortion
800 microg of vaginal misoprostol. Contraception Jan
methods. Acta Obstet Gynecol Scand 1992;71:616–23.
 Chan YF, Ho PC, Ma HK. Blood loss in termination of early
 Fiala C, Swahn ML, Stephansson O, Gemzell-Danielson K. The
pregnancy by vacuum aspiration and by combination of
effect of non-steroidal anti-inflanatory drugs on medical
mifepristone and gemeprost. Contraception 1993;47:85–95.
abortion with mifepristone and misoprostol at 13–22 weeks
 Prasad RN, Choolani M, Roy A, Ratnam SS. Blood loss in
gestation. Hum Reprod 2005;20:3072–7.
termination of early pregnancy with mifepristone and geme-
 el-Refaey H, Templeton A. Early induction of abortion by
prost. Aust N Z J Obstet Gynaecol 1995;35:329–31.
a combination of oral mifepristone and misoprostol adminis-
 Xu J, Chen H, Ma T, Wu X. Termination of early pregnancy in the
tered by the vaginal route. Contraception Feb 1994;49(2):
scarred uterus with mifepristone and misoprostol. Int J Gynecol
 Pastuszak AL, Schuler L, Speck-Martins CE, Coelho KE, Cordello
 Kim JO, Han JY, Choi JS, Ahn HK, Yang JH, Kang IS, et al. Oral
SM, Vargas F, et al. Use of misoprostol during pregnancy and
misoprostol and uterine rupture in the first trimester of
Mobius' syndrome in infants. N Engl J Med Jun 25 1998;338(26):
pregnancy. A case report. Reprod Toxicol 2005;20:575–7.
 Tang OS, Schweer H, Seyberth HW, Lee SW, Chung Ho P.
 Orioli IM, Castilla EE. Epidemiological assessment of misopros-
Pharmacokinetics of different routes of administration of
tol teratogenicity. BJOG Apr 2000;107(4):519–23.
misoprostol. Hum Reprod 2002;17(2):332–6.
 Shannon C, Brothers LP, Philip NM, Winikoff B. Infection after
 Creinin MD, Carbonell JK, Schwartz JL, Varela L, Tanda R. A
medical abortion: a review of the literature. Contraception
randomized trial on the effect of moistening misoprostol before
vaginal administration when used with methotrexate for
 Aktun H, Cakmak P, Moroy P, Minareci Y, Yalcin H, Mollamahmutoglu
abortion. Contraception 1999;59:11–6.
L, et al. Surgical termination of pregnancy: evaluation of 14,903
 Chong YS, Chua S, Arulkumaran S. Severe hyperthermia following
cases. Taiwan J Obstet Gynecol 2006;45:221–4.
oral misoprostol in the immediate post-partum period. Obstet
 Safe abortion technical and policy guidance for health systems.
Chapter 2. clinical care for women undergoing abortion. WHO
 Chong YS, Chua S, Arulkumaran S. Sublingual misoprostol for
first trimester termination of pregnancy: safety concerns. Hum
 Blum J, Winikoff B, Gemzell-Danielsson K, Ho PC, Schiavon
R, Weeks A. Treatment of incomplete abortion and mis-
 Schaff EA, Fielding SL, Eisinger SH, Stadalius LS, Fuller L.
carriage with misoprostol. Int J Gynecol Obstet 2007;99:
Low-dose mifepristone followed by vaginal misoprostol at
48 hours for abortion up to 63 days. Contraception 2000;61:
 D. Grimes, K. Shutz, N. Stangood, Immediate post abortal
insertion of intrauterine device. 2nd ed. Cochrane Database
 Tang OS, Lee SW, Ho PC. A prospective randomized study on the
Sist Rev 2004; vol. 4:CD001777, UK. John Wiley and Sons, Ltd,
measured blood loss in medical termination of early pregnancy
by three different misoprostol regimens after pretreatment
 Mittal S. Contraception after medical abortion. Contraception
with mifepristone. Hum Reprod 2002;17:2865–8.
DIABETIC KETOACIDOSIS INTRAVENOUS INSULIN CHART ONLY TO BE USED FOR THE MANAGEMENT OF DKA IN ADULTS ‘INSULIN’ SHOULD ALSO BE DOCUMENTED ON THE MAIN CHARTPlease read the prescribing and administration notes overleaf before completing this chart. Further details are available in the Trust Guideline: DKA Management 2010, available on the Intranet. 1. Replacement of circulating volume a
www.netpharm.nl BIJSLUITER Lees de hele bijsluiter aandachtig door alvorens dit geneesmiddel in te nemen. - Bewaar deze bijsluiter. Misschien heeft u hem nog een keer nodig. - Raadpleeg uw arts of apotheker, als u aanvullende vragen heeft. - Dit geneesmiddel is alleen aan u voorgeschreven. Geef het dus niet door aan iemand anders. Het kan schadelijk voor hen zijn, zelfs als ze deze