From the Research
In India, the government guidelines for medical method of abortion (MMA) recommend a combination of mifepristone followed by misoprostol for pregnancies up to 9 weeks (63 days) of gestation, with a regimen consisting of 200 mg of mifepristone orally, followed by 800 mcg of misoprostol 24-48 hours later, as supported by the most recent and highest quality study 1.
Key Points to Consider
- The procedure must be performed by a registered medical practitioner in a facility approved under the Medical Termination of Pregnancy (MTP) Act.
- Before administering MMA, providers should confirm pregnancy, determine gestational age, rule out contraindications like ectopic pregnancy, and obtain informed consent.
- Patients should be counseled about expected side effects including bleeding, cramping, and potential complications.
- A follow-up visit is recommended 10-14 days after mifepristone administration to confirm complete abortion.
- This regimen is effective because mifepristone blocks progesterone receptors, causing the pregnancy to detach, while misoprostol induces uterine contractions to expel the pregnancy, as shown in a systematic review of the effectiveness, safety, and acceptability of mifepristone and misoprostol for medical abortion in low- and middle-income countries 1.
Administration and Safety
- Misoprostol can be administered buccally, sublingually, or vaginally.
- For pregnancies between 9-12 weeks, medical supervision in a healthcare facility is required.
- Patients should be advised to seek immediate medical attention if they experience excessive bleeding, severe pain, fever, or if pregnancy symptoms persist.
- The overall efficacy of mifepristone followed by buccal misoprostol is 96.7% (95% confidence interval [CI] 96.5-96.8%) and the continuing pregnancy rate is 0.8% (95% CI 0.7-0.9%) in approximately 33,000 pregnancies through 63 days of gestation, as reported in a systematic review 2.
Evidence-Based Practice
- The use of mifepristone with misoprostol for medical abortion has been proposed and implemented to improve abortion safety, with a study showing that this regimen is highly effective and safe through 63 days estimated gestational age 3.
- A systematic review of the literature found that mifepristone and misoprostol is highly effective, safe, and acceptable to women in low- and middle-income countries, making it a feasible option for reducing maternal morbidity and mortality worldwide 1.