Guideline

Medical management of abortion

Year of Publication

2018

Issuing Institution

World Health Organization

Links

Virtual Health Library

Recommendations

11 included recommendations

For the treatment of incomplete abortion at < 13 weeks uterine size, we suggest the use of 600 μg misoprostol administered orally or 400 μg misoprostol administered sublingually

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

For the treatment of incomplete abortion at ≥ 13 weeks uterine size, we suggest the use of repeat doses of 400 μg misoprostol administered sublingually, vaginally or buccally every 3 hours

Status

Maintained

Recommended in favor

Conditional

Medical management for intrauterine fetal demise at ≥ 14 to ≤ 28 weeks of gestation. 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. The minimum recommended interval between use of mifepristone and misoprostol is 24 hours

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Medical management for intrauterine fetal demise at ≥ 14 to ≤ 28 weeks of gestation. For the misoprostol-only regimen, we suggest the use of repeat doses of 400 μg misoprostol administered sublingually every 4–6 hours

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Medical management for intrauterine fetal demise at ≥ 14 to ≤ 28 weeks of gestation. Where sublingual misoprostol is not used, we suggest the use of repeat doses of 400 μg misoprostol administered vaginally every 4–6 hours

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Medical management of induced abortion at < 12 weeks of gestation. We recommend the use of 200 mg mifepristone administered orally, followed 1–2 days later by 800 μg misoprostol administered vaginally, sublingually or buccally. The minimum recommended interval between use of mifepristone and misoprostol is 24 hours

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Medical management of induced abortion at < 12 weeks of gestation. For the misoprostol-only regimen, we recommend the use of 800 μg misoprostol administered vaginally, sublingually or buccally

Status

Maintained

Recommended in favor

Strong

Medical management of induced abortion at ≥ 12 weeks of gestation. We suggest the use of 200 mg mifepristone administered orally, followed 1–2 days later by repeat doses of 400 μg misoprostol administered vaginally, sublingually or buccally every 3 hours. The minimum recommended interval between use of mifepristone and misoprostol is 24 hours

Status

Maintained

Recommended in favor

Conditional

Medical management of induced abortion at ≥ 12 weeks of gestation. For the misoprostol-only regimen, we suggest the use of repeat doses of 400 μg misoprostol administered vaginally, sublingually or buccally every 3 hours

Status

Maintained

Recommended in favor

Conditional

For individuals undergoing medical abortion with the combination mifepristone and misoprostol regimen or the misoprostol-only regimen who desire hormonal contraception (oral contraceptive pills, contraceptive patch, contraceptive ring, contraceptive implant or contraceptive injections), we suggest that they be given the option of starting hormonal contraception immediately after the first pill of the medical abortion regimen.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

For individuals undergoing medical abortion with the combination mifepristone and misoprostol regimen or the misoprostol-only regimen who wish to have an intrauterine device (IUD) inserted, we suggest IUD placement at the time that success of the abortion procedure is determined. The use of clinical signs with bimanual examination, serum human chorionic gonadotrophin (hCG) levels or ultrasonography (if available), and an assessment of the individual’s current symptoms can be used to determine whether or not there is an ongoing pregnancy

Status

Maintained

Recommended in favor

Conditional