New figo guidelines for misoprostol use. Taille utérine 13 à 26 semaines.
FIGO’s Committee on Childbirth and Postpartum Haemorrhage (formerly Safe Motherhood and Newborn Health), in collaboration with global experts, has published a new supplement in the 157 (S1) issue of the International Journal of Gynecology and Obstetrics (IJGO) on 17 March 2022. of Essential Medicines For incomplete/inevitable abortion women should be treated based on their uterine size www. 2%; respectively, P = 0. b The minimum recommended interval between use of mifepristone and misoprostol is 24 hours. Induced Abortion. Esperar 1-2 días, V O misoprostol 50-100 μg cada 2. PPH . However, key safety considerations with its use include an increased risk of uterine rupture, tachysystole and hyperstimulation of pregnant women, which could potentially lead to a non-reassuring fetal heart rate and to fetal hypoxemia. (0-12 weeks) 600mcg (3 tabs) swallowed as a single dose. prevention of PPH in settings where oxytocin is not available. fetal death4:18-26 wks: 100mcg vaginally 6-hrly (max x. The need for a curettage subsequent to treatment was scored as a parameter of failure. FIGO regards reproductive choice, including access to safe abortion services, as a basic and non-negotiable REGIMES RECOMENDADOS 2017. Some areas were Nov 23, 2018 · Concerns about using misoprostol for induction of labour in Canada included the lack of approval for this indication by Health Canada, and the risk of serious adverse events like uterine rupture. The dose of misoprostol should be reduced as gestational age increases. Uso pós-parto. 1-3 A systematic review comparing misoprostol with Foley catheter and dinoprostone induction agents suggests that ‘Oral Nov 23, 2018 · This report provides the most up-to-date information on the use of misoprostol alone for induced abortion, induction of labour and post-partum use. Mifepristone 200mg PO Wait 1-2 days then, Misoprostol 50-100μg every 4 hours PV OR Misoprostol 50-100μg every 2 hours PO6,9. 1). International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics , 23 Jun 2017, 138 (3): 363-366. imester)400mcg vaginally or sublingually 3-hrly (max. figo. Jun 26, 2019 · This new protocol showed a comparable efficacy to the hospital-based standard vaginal 800 μg misoprostol protocol (82. Jun 30, 2021 · FIGO. Actions for midwives’ associations and OBGYN societies FIGO and ICM recommend that national professional midwives’ associations and obstetrics and gynaecology societies have an important and collaborative role to play in: • the dissemination and implementation of these recommendations for the use of uterotonics in FIGO recognises the persistent need for induced abortion and post-abortion care beyond 12 weeks of pregnancy. BU/SL/PV5,9. 2,3 Misoprostol may be especially useful in the resource-limited countries where alternative prostaglandins (Prostaglandin E2) preparations are Jun 23, 2017 · The “FIGO Misoprostol-only Recommended Regimens 2017” chart – published in the International Journal of Gynecology and Obstetrics, accompanied by a commentary – is the result of extensive collaboration between an international expert group, including Gynuity Health Projects. 1-4, 6-8, 10 SOGC mentions carbetocin as a uterotonic available for treatment, 5 and the German/Austrian/Swiss guidelines highlight that the use of carbetocin to treat PPH is currently not Dosage Guidelines. org Profilaxia da hemorragia pós-parto (HPP) 2,10 600 μg VO (x1) ou prevenção secundária da HPP 11 (perda de sangue aprox. epristone + misoprostol Included in the WHO Model L. Jun 29, 2017 · In 0193, the International Federation of Obstetrics and Gynecology (FIGO) produced guidelines for an prevention real treatment of PPH with misoprostol along with a chart detailing recommended dosages of misoprostol when second alone for a variety are gynecologic and obstetric indications. Methods : A web-based survey was sent by email to 130 national societies of obstet- Results. 6 In 2012, FIGO published its guidelines indicating 800µg misoprostol for the treatment of PPH. Int J Gynaecol Obstet. Mar 25, 2017 · It is recommended for this indication by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the Society of Obstetricians and Gynaecologists of Canada (SOGC). (approx. Nov 4, 2020 · The primary audience for these recommendations includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to PPH prevention and treatment) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and Jun 1, 2017 · The guidance, available in the form of a chart and divided by stages of pregnancy, provides recommendations for dosages and routes of administration for misoprostol use in obstetrics and gynecology, including: medically induced abortion, medical management of miscarriage, cervical preparation for surgical abortion, fetal death, induction of administered with a syringe. g orally 2-hrlydDo not use if previous caesarean section. 5,9Aborto inducido Mifepristona 200 mg VO. In contrast to the ACOG, NICE and FIGO guidelines, the AWMF guideline recommends medical management only up to week 9 + 0 of pregnancy as it less effective compared to surgical treatment (94. The chart, divided by stages of pregnancy, provides May 26, 2023 · A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination. External experts and WHO staff involved in the preparation of the guidelines 33 A. 800 μg SL toutes les 3 heures ou VV*/Bucc toutes les 3–12 heures (2–3 doses) Grossesse arrêtée (œuf clair)c,2. Interruption de grossessea,b,1. > 26 semanas de gestação8. Monitor fetal heart rate with cardiotocography and wait at least 6 hours after prostaglandin removal before starting oxytocin. The combination of 200mg of mifepristone followed by 25 μg to 800 μg (depending on gestational age) of misoprostol has been shown to be effective for the termination of pregnancy throughout gestation. The correct dosage varies greatly according to gestation, indication and route of administration - using the correct dosage is vital for success and to prevent complications. The article explains, based on the available evidence, how the authors took decisions on what to recommend. Jun 29, 2017 · In 5002, the Internationally Federation of Obstetrics or Gynecology (FIGO) fabricated guidelines for the prevention and cure of PPH with misoprostol along with a chart detailing recommended dosages of misoprostol once used alone for a variety starting gynecologic and obstetric indications. In. Jun 22, 2017 · The new FIGO 2017 misoprostol-only dosage chart has been released! An update from the widely used 2012 chart detailing recommended dosages of misoprostol when used by itself for a variety of gynecological and obstetrical indications has been revised and expanded by an expert group and is now available online: Published as an open access special Feb 19, 2024 · According to The International Federation of Gynecology and Obstetrics (FIGO) guidelines, misoprostol alone can be used for up to 13 weeks (off-label use) for termination of pregnancy. BJOG, 2015 k 11FIGO Guidelines: Treatment of PPH with misoprostol, 2012 Vía de administración VV: vía vaginal VSl: vía sublingual (debajo de la lengua) VO: vía oral VB: vía bucal (entre la mejilla y la encía) * En caso de hemorragia y/o signos de Give 2 doses and leave to work for 1-2 weeks (unless heavy bleeding or infection) Incomplete abortion. Jul 13, 2023 · This review assessed the efficacy and safety of pharmacologic agents (prostaglandins, oxytocin, mifepristone, hyaluronidase, and nitric oxide donors) and mechanical methods (single- and double-balloon catheters, laminaria, membrane stripping, and amniotomy) and those generally considered under the rubric of complementary medicine (castor oil, nipple stimulation, sexual intercourse, herbal given in some internationaland nationalclinical guidelines to use lower doses of misoprostol in cases of fetal death. (13-24 weeks and 25-26 weeks) Mifepristone & Misoprostol Dosing Chart Recommended Regimens 2023 ≤12 weeks 13-17 weeks 18-24 weeks 25-27 weeks ≥28 weeks Postpartum Use Induced Abortion Mifepristone 200mg PO Wait 1-2 days then, Misoprostol 800μg BU/SL/PV x1 ≥10 weeks give misoprostol BU/SL/PV every 3 hours until expulsion1 Induced Abortion Mifepristone 200mg PO or PPH secondary prevention11. 800 μg VSl a cada 3 horas. Highlights of the guidelines include the following [ 85] : Prevention of PPH. The key findings were that many countries lacked comprehensive, up‐to‐date, evidence‐based national guidelines providing guidance on misoprostol use; recommended regimens were very different in the national guidelines as well as between international and regional guidelines that are most often used as Effects and side effects. Utilisation post-partum. labour2,525mcg vaginally 6-hrly or 25 m. Participants in the WHO Technical Consultation (13–14 April 2010) 33 C. In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misopros-tol when used alone, for a variety of gynecologic and obstetric indica-tions. In our clinical experience, we have applied a misoprostol regimen following the International Federation of Gynecology and Obstetrics (FIGO) guidelines for many years, and we standardize the Jun 29, 2017 · By 2012, the Internationally Federation of Obstetrics and Gynecology (FIGO) produced guidelines for aforementioned prevention or treatment for PPH because misoprostol along with a chart detailing recommended dosages of misoprostol when used alone for a variety of gynecologic and obstetric notes. the use of ergometrine. In situations where skilled birth attendants are unavailable, WHO guidelines advocate misoprostol use 8 for PPH prevention while the International Confederation of Midwives and the International Federation of Gynaecology and Obstetrics (ICM/FIGO) suggest using misoprostol in all situations where oxytocin is not available. Reduce doses in women with previous caesarean section. The U. Misoprostol should be administered by healthcare workers trained in its use during the third stage of labor, soon after birth of the infant, to reduce the occurrence of PPH [11,12]. FIGO is dedicated to the improvement of women's health and rights and to the reduction of disparities in healthcare available to women and newborns Feb 19, 2013 · dose vaginal misoprostol (every 6 hours) or oral misoprostol (every. MISOPROSTOL-ONLY. Taille utérine < 13 semaines. 1002/ijgo. Le tableau peut être téléchargé comme une planche murale gratuite en format PDF. Mar 17, 2022 · Read the full supplement. The table below gives this information. and can be simply treated using anti-pyretics and physical cool-ing. 182). 13–26 semanas de gestação. or. Prolonged or serious effects and side effects are rare. Some areas were particularly challenging to develop given 800mcg sublingually 3-hrly or vaginally/buccally every 3-12hrs (2-3 doses) Ideally used 48h after mifepristone 200mg. 73. S. Recommendations of FIGO are 800 mcg of misoprostol given sublingually administered every 3 hours. TXA plus misoprostol versus placebo plus misoprostol. In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing guidelines for the prevention and treatment of PPH with misoprostol and recommended doses of misoprostol when used alone for various gynecological and obstetrics and gynecological indications. For fetal death. It Jul 29, 2016 · As early as 2006, the International Confederation of Midwives and the International Federation of Gynecology and Obstetrics (FIGO) recommended that misoprostol for the treatment of PPH may be appropriate for use in low-resource settings as a stand-alone treatment, in combination with oxytocin, and as a last resort for PPH treatment. doi: 10. TXA plus misoprostol was compared to placebo plus misoprostol in low/middle income countries. Some use misoprostol purely for cervical ripening and replace it with an Jun 23, 2017 · In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. Irrespectiveof the issue of recommendationsfor differentdoses, various reviews15,20,21 have concluded that there is insufficientevidence overall of superior-ity of one dose or schedule of misoprostol over another for use in Jun 23, 2017 · University Medical Center, Utrecht, Netherlands. We suggest the use of 200 mg mifepristone administered orally, followed 1–2 days later by repeat doses of 400 μg misoprostol administered sublingually or vaginally every 4–6 hours. EW INDICATION: SECONDARY PREVENTION OF . 12181. FIGO’s vision is that women of the world achieve the highest possible standards of physical, mental, reproductive and sexual health and wellbeing throughout their lives. 5Aborto inducido Mifepristona 200 mg VO. A single dose of misoprostol 600 μg orally is indicated for. found here. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. Leave to work for 2 weeks (unless heavy bleeding or infection) Induced abortion. Guideline development group at WHO 33 B. Of countries that do have national guidelines, 41% don’t include advice on misoprostol to prevent and treat PPH; 42 (61%) of respondents reported that misoprostol was listed on their national EML; 29% reported that misoprostol was not widely available; 28% reported a lack of supportive policy or programs for use of misoprostol; Read the full Mifepristone 200mg PO Wait 1-2 days then, Misoprostol 200μg every 4 hours until expulsion. This protocol was effective Mar 6, 2024 · In a retrospective study at the OVG University Women's Hospital, records of patients with early miscarriage and medical treatment using Misoprostol from 2018-2021 were reviewed for this purpose. Some areas were 8. FIGO is a professional organisation that brings together more than 130 obstetrical and gynaecological associations from all over the world. 2002;187(4):853-7. Most women have complete expulsion before use of 5 doses, but other studies continued beyond 5 and achieved a higher total success rate with no safety issues. <13 weeks’ gestation. FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. May 9, 2015 · The International Federation of Gynecology and Obstetrics (FIGO) has published guidelines on the prevention and management of postpartum hemorrhage (PPH). 9 POSOLOGIES RECOMMANDÉES 2017. Mifepristone and misoprostol in combination or, where mifepristone is unavailable, misoprostol alone, are the recommended medications to induce abortion, and to manage incomplete abortion, or ‘intrauterine fetal demise’ – the clinical term used to describe the death of a An update from the widely used 2017 guidance, the 2023 charts detail recommended dosages of mifepristone and misoprostol when used for a variety obstetrical indications, including induced abortion, missed abortion, incomplete abortion, cervical preparation before aspiration and D&E, fetal demise, induction of labour, prophylaxis and treatment MISOPROSTOL-ONLY RECOMMENDED REGIMENS 2017. RECOMMENDED. This review aims to review the clinical effectiveness, cost-effectiveness, and evidence-based guidelines regarding the use of misoprostol for cervical ripening and induction of labour. Oct 8, 2023 · Misoprostol ($0. Both FIGO and WHO produced guidelines for prevention and treatment of PPH in 2012 (in 2017 FIGO produced an updated misoprostol only recommended dosage chart, but no changes were made to the recommended dosages for use of misoprostol for PPH management); therefore, misoprostol can serve as an interesting FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics jessica morris 2017, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics programs to broaden access and availability of misoprostol for each of its women’s health indications. oral misoprostol, and a tem-perature of over 38°C in around 5%. 7 However, it was not until 2015 that the WHO included this drug on the list of 0 μg cada 3 horas BUC/SL/PV hasta la expulsión. www. Shivering has been reported in 37–47% of women following administration of 800 μg sublingual misoprostol Nov 2, 2018 · Both FIGO and WHO produced guidelines for prevention and treatment of PPH in 2012 (in 2017 FIGO produced an updated misoprostol only recommended dosage chart, but no changes were made to the recommended dosages for use of misoprostol for PPH management); therefore, misoprostol can serve as an interesting point of comparison for both Jul 21, 2023 · The use of vaginal misoprostol according to the gestational age is recommended for uterine evacuation in case of fetal death: at 13-26 weeks, 200 mcg every 4-6 hours; at 27-28 weeks, 100 mcg every 4-6 hours; and over 28 weeks, 25 mcg every six hours. Oct 28, 2019 · In 2006, the International Federation of Gynecology and Obstetrics (FIGO) recommended the use of misoprostol to treat PPH, especially in locations with scarce resources. Le tableau complet des doses recommandées de FIGO peut être téléchargé ici. 5- Several studies limited dosing to 5 times; for use between 13-26 weeks' gestation. Abortion care in this gestational age range should be accessible and facilitated for those who need it, including for post-abortion care or any treatment needed by women and girls who have attempted to self-induce an abortion. Role of combination of mifepristone and misoprostol verses misoprostol alone in induction of labour in late intrauterin fetal death: A prospective study. Some protocols use a single dose for the whole induction period, whereas others escalate the dose until the desired effect is achieved. Epub 2017 Jun 23. 800μg sl every 3 hours or pv*/bucc every 3–12 hours (2–3 doses) In one double blind RCT involving 1,229 home births attended by traditional birth atten-dants (TBAs) in rural Gambia, 600 μg oral misoprostol was compared with 2 mg oral ergometrine. All symptoms are transient. who have not had a previous cesarean delivery ( Table 1). μg cada 4 horas BUC/SL/PV hasta la expulsión. We systematically reviewed PubMed articles published between 2008 and 2022 and reviewed reference lists of included articles to New FIGO Guidelines for Misoprostol Use – Maternal Health Task Force, This item may require 1-2 days to ship out from our Product Information: Power-Trialysis Short-Term Triple-Lumen Dialysis Catheter Kit, Nov 2, 2018 · Both FIGO and WHO produced guidelines for prevention and treatment of PPH in 2012 (in 2017 FIGO produced an updated misoprostol only recommended dosage chart, but no changes were made to the recommended dosages for use of misoprostol for PPH management); therefore, misoprostol can serve as an interesting point of comparison for both Jun 23, 2017 · In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. Mifepristone is not indicated for induction of labor with a live fetus Jun 23, 2017 · In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. ≥ 350 ml) 800μg VSl (x1) Tratamento da HPP 2,10 800 μg VSl (x1) 1 Se a mifepristona estiver disponível (preferencial), siga o regime posológico prescrito para mifepristona + misoprostol 2 Incluído na multaneous) use of misoprostol when giv-en in conjunction with conventional utero-tonics for treatment of PPH [Widmer 2010, Zuberi 2008, Walraven 2004, Hofmeyr 2004]. N. Click on the article title to read more. BJOG, 2015 k 11FIGO Guidelines: Treatment of PPH with misoprostol, 2012 Vía de administración VV: vía vaginal VSl: vía sublingual (debajo de la lengua) VO: vía oral VB: vía bucal (entre la mejilla y la encía) * En caso de hemorragia y/o signos de 0 μg cada 3 horas BUC/SL/PV hasta la expulsión. 2,14 There are only 2 clinical trials on misoprostol-alone regimens that use the currently endorsed regimen Mar 7, 2014 · On the occasion of International Women’s Day (8 March), the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are pleased to launch a joint statement on the use of misoprostol for the treatment of postpartum haemorrhage. 6- For postpartum use, only where oxytocin is not available or storage conditions are inadequate . Our hospital-based standard protocol of vaginal 800 μg misoprostol is that recommended by FIGO for medical treatment of first-trimester early pregnancy loss . luego: misoprostol 200. WHO Secretariat 34 Annex 2. The data was analyzed using Statistical Package for the Social i FIGO Guidelines: Prevention of PPH with misoprostol, 2012 j Raghavan et al. ou VV*/VB a cada 3–12 horas (2–3 doses) May 15, 2017 · Published randomised trials have a wide variety of misoprostol doses (20–200 μ g) and frequency of administration (1–6 hourly). Mar 17, 2022 · When oxytocin fails to control PPH, guidelines recommend the use of an additional drug, such as ergot alkaloids, injectable prostaglandins, or misoprostol. 2 hours) are recommended for induction of labor at term in women. 2017. Updating of the guidelines 30 References 31 Annex 1. Les doses recommandées de Misoprostol (Cytotec®) sont fournies dans ce site avec les instructions pour leur utilisation. To prevent PPH, a uterotonic drug should be routinely administered during the third stage of labor in all births. Nov 1, 2018 · The key findings were that many countries lacked comprehensive, up-to-date, evidence-based national guidelines providing guidance on misoprostol use; recommended regimens were very different in POSOLOGIES RECOMMANDÉES 2017. ≥350ml blood loss) 800μg sl (x1) tment2,10800μg sl (x1) If mifepristone is available (preferable), follow the regimen prescribed for. DOI: 10. Two trials compared adjunct use of Treatment of Post-Partum Haemorrhage with Misoprostol FIGO GUIDELINE 3564 Annotated English Treatment:Layout 1 3/8/12 15:31 Page 2 . Pregnancy termination1. Taille utérine > 26 semaines8. 22 At the Aug 28, 2023 · Pharmacological agents such as prostaglandins (dinoprostone and misoprostol) are commonly used to reduce the duration of labor and promote vaginal delivery. Completed surveys were received from 69 societies, for a 53% response rate. 12181 PMID: 28643396. PPH prophylaxis. 3% vs. The use of misoprostol at an initial dose of 25 mcg vaginally every 4-6 hours is recommended Mar 1, 2023 · FIGO. Oxytocin after the administration of misoprostol, wait 4 hours before starting the oxytocic perfusion. 6% Use of misoprostol in obstetrics and gynaecology. 7×4) low cost tablet and widely available: Use first given that it is safe and effective. There was no important difference or no evidence of an important difference, between interventions for blood loss volume, need for additional pharmacological or surgical management. Gynecology (FIGO) produced a chart detailing recommended dos-ages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. Missed abortion. Education of women and birth attendants in the proper use of misoprostol is essential. Some areas were ABSTRACT: Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. The chart, last revised in 2012, has been expanded to include a new indication for PPH management -- secondary prevention of PPH -- based on evidence from Gynuity’s trials. In light of new evidence 1-13 and through expert deliberation, this chart has now been revised and expanded (Fig. In light of new evidence1–13 and through expert deliberation, this chart has now been revised and expanded (Fig. Aug 1, 2019 · Medical abortion plays a crucial role in the provision of access to safe, effective and acceptable abortion care. The supplement provides a comprehensive 2 days ago · Welcome to FIGO (The International Federation of Gynecology and Obstetrics) - the only organisation that brings together professional societies of obstetricians and gynecologists on a global basis. i FIGO Guidelines: Prevention of PPH with misoprostol, 2012 j Raghavan et al. )c. REGIMENS. 6 Several studies limited dosing to 5 times; most women have complete expulsion before use of 5 doses, but other studies continued beyond 5 and achieved a higher total success rate with no safety issues The World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the Society of Obstetricians and Gynecologists of Canada all endorse it for this use (SOGC). Scoping and prioritization of the topics covered in the Oct 9, 2023 · The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7 and 27 6/7 weeks of gestation, with a focus on mifepristone-misoprostol and misoprostol-only regimens. org. The most common known side effects associated with misoprostol are: Fever/Shivering: Shivering, chills and/or fever are associated with use of misoprostol. Unsafe abortion remains a catastrophic public health problem accounting for up to 13% of maternal mortality worldwide, with hundreds of thousands of survivors living with long-term complications, including infertility and chronic pain. 13–26 weeks’ gestation. parto (HPP)Misoprostol 600 μg SL . Taille utérine 13 à 26 semaines. While there were no significant differences in measured post-partum blood loss ≥ 500 mL or post-partum Hb < 8 g/dL, misoprostol was more effective at reduc-ing Oct 27, 2023 · The aim of much of the clinical literature on misoprostol alone was to establish recommended dosing and administration routes; as a result, clinical data on the effectiveness of currently endorsed misoprostol-alone protocols are sparse. Ame J Obstet Gynecol. 400mcg (2 tabs) taken under the tongue as a single dose a. on PPH management. The most common adverse effects are transient shivering and pyrexia. < 13 semanas de gestação. c,2 (1st Trimester) 800mcg vaginally 3-hrly (x2) or 600mcg sublingual 3-hourly (x2) Give 2 doses and leave to work for 1-2 weeks (unless heavy bleeding or infection) Incomplete abortion. Interrupção da gravideza,b,1. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. Prophylaxis of Postpartum hemorrhage (PPH) reflect new scientific evidence on misoprostol, and determine the challenges faced in their implementation. Panda S, Jha V, Singh S. 2017 Sep;138 (3):363-366. di xb he gw px bv zh ag vn cj
