PGTOP

Medical abortion regimens using 200 mg oral mifepristone and misoprostol are effective and appropriate at any gestation (1).

Prostaglandins in the form of pessaries (gemeprost) were used historically , however, the use of misoprostol are recommended today.

• Recommended regimens are as follows:
  • at ≤49 days of gestation
    • 200 mg oral mifepristone followed 24–48 hours later by 400 micrograms of oral misoprostol
  • at ≤63 days of gestation
    • mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 micrograms (vaginal, buccal or sublingual)
    • for women at 50–63 days of gestation, if abortion has not occurred 4 hours after administration of misoprostol, a second dose of misoprostol 400 micrograms may be administered vaginally or orally (depending on preference and amount of bleeding)
  • between 9 and 13 weeks of gestation
    • mifepristone 200 mg orally followed 36–48 hours later by misoprostol 800 micrograms vaginally
    • maximum of four further doses of misoprostol 400 micrograms may be administered at 3-hourly intervals, vaginally or orally
  • between 13 and 24 weeks of gestation
    • mifepristone 200 mg orally, followed 36–48 hours later by misoprostol 800 micrograms vaginally, then misoprostol 400 micrograms orally or vaginally, 3-hourly, to a maximum of four further doses
    • if abortion does not occur, mifepristone can be repeated 3 hours after the last dose of misoprostol and 12 hours later misoprostol may be recommenced

Reference:

1. Royal college of obstetricians and gynaecologists (RCOG) 2011. The care of women requesting induced abortion. Evidence based clinical guideline number 7.