Bibliographic Info
GuidelineMedical management of abortion
Year of Publication2018
Issuing InstitutionWorld Health Organization
Recommendation
Status
Maintained
Recommended in favor
Conditional
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
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.Evidence suggests that vaginal route is the most effective. Consideration for patient and provider preference suggests the inclusion of all routes, including buccal administration.
- 4.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
- 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 recommendation has been updated from the WHO 2012 Safe abortion guidance. For this recommendation, the combination regimen (mifepristone and misoprostol) does not have the loading dose of 800 μg misoprostol as in the prior guidance. For both the combination regimen and the misoprostol-only regimen, the buccal route has been added as an option. Maximum number of doses has been removed and the time period between mifepristone and misoprostol dosing is given in days
Also Featured In
This recommendation also appears in the following guidelines:
Guideline
Abortion care guideline
Year2022
InstitutionWHO
Guideline
Abortion care guideline, 2nd ed
Year2024
InstitutionWorld Health Organization