What is the recommended dose schedule for Medical Termination of Pregnancy (MTP)?

Recommended Dose Schedule for Medical Termination of Pregnancy (MTP)

The most effective regimen for medical termination of pregnancy includes 200 mg of oral mifepristone followed by 800 mcg of misoprostol administered buccally or vaginally, with specific timing based on gestational age. 1

First Trimester MTP (Up to 9 weeks/63 days)

• For pregnancies up to 63 days of amenorrhea, administer 200 mg oral mifepristone followed 36-48 hours later by 800 mcg misoprostol either buccally or vaginally 1
• While the traditional dose of mifepristone was 600 mg, studies show that 200 mg appears to be equally effective 2
• Success rates vary by gestational age:
  • ≤49 days: 92% success rate 3
  • 50-56 days: 83% success rate 3
  • 57-63 days: 77% success rate 3
• Approximately 49% of women will experience pregnancy termination within 4 hours of misoprostol administration, and 75% within 24 hours 3

Second Trimester MTP (12-20 weeks)

• For second trimester terminations, administer 200 mg oral mifepristone followed 36-48 hours later by 800 mcg vaginal misoprostol 4, 5
• Follow with 400 mcg misoprostol doses every 3 hours, up to a maximum of four additional doses in 24 hours 4
• This regimen achieves a 97.9% success rate within 24 hours and 99.5% within 36 hours 4
• The median induction-to-abortion interval is approximately 6.5-6.7 hours 4, 5
• Nulliparous women typically take longer to abort (7.6 hours) compared to multiparous women (6.0 hours) 4

Important Considerations and Monitoring

• Cramping and vaginal bleeding are expected effects, with bleeding lasting an average of 9-16 days 1
• Common side effects include:
  • Abdominal pain (increases with advancing gestational age) 3
  • Nausea, vomiting, and diarrhea (more common in nulliparous women) 4, 3
  • Low-grade fever 1
• These side effects can be managed with NSAIDs or antiemetics 1
• Surgical evacuation may be required in approximately 5% of cases for incomplete abortion or retained placenta 4

Follow-up and Confirmation of Complete Abortion

• Follow-up should be scheduled approximately 15 days after administration of mifepristone 3
• Confirmation of complete abortion can be assessed through:
  • Clinical history 1
  • Serial quantitative beta-hCG levels 1
  • Urine pregnancy testing 1
  • Ultrasonography when indicated 1

Contraindications

• Absolute contraindications include:
  • Confirmed or suspected ectopic pregnancy 1
  • Chronic adrenal failure 6
  • Concurrent long-term corticosteroid therapy 6
  • History of allergy to mifepristone, misoprostol, or other prostaglandins 6
  • Hemorrhagic disorders or concurrent anticoagulant therapy 6
  • Inherited porphyrias 6

Cautions

• Rare complications include ongoing pregnancy, infection, hemorrhage, undiagnosed ectopic pregnancy, and need for unplanned uterine aspiration 1
• For patients with renal impairment, careful monitoring is required, and they should be managed in experienced centers with appropriate emergency support services 7
• For high-risk patients, management should be in experienced centers with on-site emergency capabilities 8