Bibliographic Info
GuidelineAbortion care guideline, 2nd ed
Year of Publication2024
Issuing InstitutionWorld Health Organization
Recommendation
Status
Maintained
Recommended in favor
Conditional
Certainty of evidence
Low
For medical management of intrauterine fetal demise (IUFD) at ≥ 14 to ≤ 28 weeks: Suggest the use of combination mifepristone plus misoprostol over misoprostol alone; Suggested regimen: 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; Alternative regimens: repeat doses of 400 μg misoprostol administered sublingually or vaginally every 4–6 hours.
Notes and Remarks
- 1.In this guideline, duration of pregnancy (gestation) is the size of the uterus, estimated in weeks, based on clinical examination, that corresponds to a pregnant uterus of the same gestational age dated by last menstrual period (LMP).
- 2.Combination regimen is recommended because it is more effective.
- 3.Repeat doses of misoprostol can be considered when needed to achieve success of the abortion process. In this guideline we do not provide a maximum number of doses of misoprostol. Health-care providers should use caution and clinical judgement to decide the maximum number of doses of misoprostol in pregnant individuals with prior uterine incision. Uterine rupture is a rare complication; clinical judgement and health system preparedness for emergency management of uterine rupture must be considered with advanced gestational age
- 4.Data related to gestational ages over 24 weeks of gestation were more limited.
- 5.The use of a loading dose of misoprostol is not necessary. There is no advantage to the use of moistened over dry misoprostol.
- 6.This is a new recommendation
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
Medical management of abortion
Year2018
InstitutionWorld Health Organization
Guideline
Abortion care guideline
Year2022
InstitutionWHO