BOX 2Recommended methods for medical abortion

The recommended method for medical abortion is mifepristone followed by misoprostol

For pregnancies of gestational age up to 9 weeks (63 days)

The recommended method for medical abortion is mifepristone followed 1 to 2 days later by misoprostol. [See notes below for dosages, and routes of administration.]

(Strength of recommendation: strong. Quality of evidence based on randomized controlled trials: moderate.)

Dosages and routes of administration for mifepristone followed by misoprostol

Mifepristone should always be administered orally. The recommended dose is 200 mg.

Administration of misoprostol is recommended 1 to 2 days (24 to 48 hours) following ingestion of mifepristone.

  • For vaginal, buccal or sublingual routes, the recommended dose of misoprostol is 800 μg.
  • For oral administration, the recommended dose of misoprostol is 400 μg.
  • With gestations up to 7 weeks (49 days) misoprostol may be administered by vaginal, buccal, sublingual or oral routes. After 7 weeks of gestation, oral administration of misoprostol should not be used.
  • With gestations up to 9 weeks (63 days) misoprostol can be administered by vaginal, buccal or sublingual routes.

See also: Annex 5, Recommendation 2, page 113.

For pregnancies of gestational age between 9 and 12 weeks (63–84 days)

The recommended method for medical abortion is 200 mg mifepristone administered orally followed 36 to 48 hours later by 800 μg misoprostol administered vaginally. Subsequent misoprostol doses should be 400 μg, administered either vaginally or sublingually, every 3 hours up to four further doses, until expulsion of the products of conception.

(Strength of recommendation: weak. Quality of evidence based on one randomized controlled trial and one observational study: low.)

See also: Annex 5, Recommendation 3, page 114.

For pregnancies of gestational age over 12 weeks (84 days)

The recommended method for medical abortion is 200 mg mifepristone administered orally followed 36 to 48 hours later by repeated doses of misoprostol.

[See notes below for dosages, and routes of administration of misoprostol.]

(Strength of recommendation: strong. Quality of evidence based on randomized controlled trials: low to moderate.)

  • With gestations between 12 and 24 weeks, the initial misoprostol dose following oral mifepristone administration may be either 800 μg administered vaginally or 400 μg administered orally. Subsequent misoprostol doses should be 400 μg, administered either vaginally or sublingually, every 3 hours up to four further doses.
  • For pregnancies beyond 24 weeks, the dose of misoprostol should be reduced, due to the greater sensitivity of the uterus to prostaglandins, but the lack of clinical studies precludes specific dosing recommendations.

See also: Annex 5, Recommendation 6, page 115.

Where mifepristone is not available

For pregnancies of gestational age up to 12 weeks (84 days)

The recommended method of medical abortion is 800 μg of misoprostol administered by vaginal or sublingual routes. Up to three repeat doses of 800 μg can be administered at intervals of at least 3 hours, but for no longer than 12 hours.

(Strength of recommendation: strong. Quality of evidence based on one randomized controlled trial: high.)

See also: Annex 5, Recommendation 4, page 115.

For pregnancies of gestational age over 12 weeks (84 days)

The recommended method of medical abortion is 400 μg of misoprostol administered vaginally or sublingually, repeated every 3 hours for up to five doses.

(Strength of recommendation: strong. Quality of evidence based on one randomized controlled trial: low to moderate.)

  • For pregnancies beyond 24 weeks, the dose of misoprostol should be reduced, due to the greater sensitivity of the uterus to prostaglandins, but the lack of clinical studies precludes specific dosing recommendations.

See also: Annex 5, Recommendation 6, pages 115 and 116.

From: Executive summary

Cover of Safe Abortion
Safe Abortion: Technical and Policy Guidance for Health Systems. 2nd edition.
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