What medication can be used to terminate a confirmed pregnancy?

Medication Options for Early Pregnancy Termination

For pregnancy termination up to 7 weeks (49 days), mifepristone 200 mg orally followed by misoprostol 800 mcg administered vaginally or buccally is the most effective medical regimen with success rates of approximately 92-97%. 1, 2

First-Line Medication Regimen

Up to 7 weeks (49 days) gestation:

• Mifepristone 200 mg orally
• Followed by misoprostol 800 mcg vaginally or buccally 24-48 hours later
• Success rate: 92-97% 2, 3

7-9 weeks (50-63 days) gestation:

• Same medication regimen
• Success rates decline with advancing gestational age:
  • 50-56 days: 83% success
  • 57-63 days: 77% success 3

Alternative Regimen (if mifepristone unavailable)

• Misoprostol 800 mcg buccally alone
• Lower success rate (74% vs 92% with combined regimen) 4
• Higher risk of continued pregnancy (4% vs 0% with combined regimen) 4

Administration Considerations

• Termination should be performed in a hospital setting rather than outpatient facility, especially for high-risk patients 1
• The first trimester is the safest time for elective pregnancy termination 1
• Monitoring is required during and after administration:
  • Vital signs monitoring
  • Oxygen saturation monitoring when prostaglandin compounds are given 1

Expected Effects and Side Effects

• Cramping and bleeding (expected)
  • Bleeding lasts 9-16 days on average 2
• Side effects more common with simultaneous administration:
  • Nausea
  • Diarrhea
  • Warmth or chills 5
• Side effects increase with advancing gestational age 3

Safety Considerations

Avoid in patients with:

• Severe cardiovascular disease
• Pulmonary hypertension (prostaglandin F compounds should be avoided) 1

Potential complications (rare):

• Heavy uterine bleeding
• Pelvic infection
• Ongoing pregnancy
• Need for surgical intervention 2, 6

Follow-up Assessment

• Clinical evaluation 7-14 days after treatment
• Confirmation of complete abortion through:
  • Clinical history
  • Serial quantitative beta-hCG levels
  • Urine pregnancy testing
  • Ultrasonography 2

Important Cautions

• Saline abortion methods should be avoided due to risk of intravascular volume expansion, heart failure, and clotting abnormalities 1
• Prostaglandin F compounds should be avoided in patients with pulmonary hypertension 1
• Success rates decrease significantly with advancing gestational age 3
• Hospitalization and surgical intervention rates increase with advancing gestational age (2% at ≤49 days vs 4% at 50-63 days) 3

The medication regimen should be administered under proper medical supervision, with appropriate follow-up to confirm complete abortion and address any complications.