Management of Fever in Medical Termination of Pregnancy with Misoprostol

Paracetamol Use for Fever Management

The American College of Physicians recommends premedication with paracetamol/acetaminophen to reduce fever and chills associated with prostaglandin administration, with a dosage of 650-1000 mg orally every 4-6 hours (maximum 4 g/day) for patients capable of oral intake 1, 2
Paracetamol should be administered 30-60 minutes before misoprostol to prevent or minimize fever and shivering, with its antipyretic effect beginning within hours but may take up to 4 hours to reach maximum effect 1, 3

Patients undergoing medical termination of pregnancy with misoprostol should be monitored for temperature hourly for the first 3 hours after misoprostol administration and continue paracetamol every 4-6 hours as needed for fever or discomfort 2
If fever persists beyond 3-4 hours or exceeds 40°C, ibuprofen (NSAID) can be added as second-line therapy, and patients should be encouraged to drink up to 2 liters of fluid daily to prevent dehydration 2, 3

The Royal College of Obstetricians and Gynaecologists advises against withholding paracetamol due to the presence of fever, as it is both safe and indicated, and against automatically prescribing antibiotics for fever in the first 24 hours post-misoprostol 1, 2