What is the recommended dose of misoprostol (MTP kit) to be given per vaginum (PV) for abortion?

Misoprostol Dosage for Medical Termination of Pregnancy (MTP)

For medical termination of pregnancy, the recommended dose of misoprostol to be given per vaginum (PV) is 800 μg. 1

Dosing Regimens

• The optimal regimen for second-trimester abortion is 400 μg of misoprostol administered vaginally every 3-6 hours 1
• For first-trimester abortion (up to 63 days gestation), 800 μg of misoprostol administered vaginally is the recommended dose 2
• When used as part of an MTP kit (with mifepristone), the standard protocol involves:
  • Mifepristone 200 mg orally, followed by
  • Misoprostol 800 μg vaginally, typically 24-48 hours later 2, 3

Timing Considerations

• The conventional timing between mifepristone and misoprostol administration is 24-48 hours, which has shown higher efficacy (96.9% complete abortion rate) 3
• Same-day administration (6-hour interval) has been studied but shows lower efficacy (89% complete abortion rate) compared to the standard 36-48 hour protocol (96% complete abortion rate) 4
• Misoprostol can be administered 1-3 days after mifepristone with similar efficacy rates (96-98%) 5

Dosage Efficacy

• The 800 μg dose of misoprostol has demonstrated superior efficacy (94.2% complete abortion rate) compared to the 400 μg dose (90.5% complete abortion rate) 2
• Higher doses (>800 μg) are associated with increased side effects, particularly diarrhea, without significant improvement in efficacy 1

Route of Administration

• Vaginal administration is associated with fewer side effects compared to sublingual administration, while maintaining similar efficacy 2
• Both routes have comparable complete abortion rates (difference of -0.7%, 95% CI -2.6-1.2%) 2

Important Precautions

• Misoprostol should be avoided in women with previous cesarean delivery due to the risk of uterine rupture 6, 7
• Medical termination should be performed in healthcare facilities where blood transfusion and emergency surgery are available, especially for second-trimester abortions 7
• Women with a scarred uterus who must use misoprostol should receive lower doses and should not double the dose if there is no initial response 1

Common Side Effects

• Gastrointestinal symptoms (nausea, vomiting, diarrhea) are common side effects 6, 7
• Other side effects include fever/rigors and pain 7
• Monitoring of systemic arterial oxygen saturation with a transcutaneous pulse oximeter is recommended when using prostaglandin E compounds 7

Alternative Options

• For high-risk patients or when medical termination is not appropriate, surgical evacuation (dilatation and evacuation) has a lower risk of prolonged bleeding 6, 7
• Dilatation and evacuation is considered the safest procedure for both first and second trimesters when surgical evacuation is feasible 7