Medical Abortion Regimen
The recommended regimen for medical abortion is mifepristone 200 mg orally followed by misoprostol 800 mcg administered buccally or vaginally, effective through 70 days (10 weeks) from the last menstrual period. 1, 2
Standard Protocol
Medication Dosing
- Mifepristone 200 mg taken orally on day 1 1, 3
- Misoprostol 800 mcg administered buccally or vaginally 24-48 hours after mifepristone 1
- Simultaneous administration (same day) is also effective if preferred, though may cause more immediate side effects like nausea and diarrhea 4
Gestational Age Limits
- FDA-approved protocol originally specified up to 49 days from last menstrual period 5
- Current evidence supports safe and effective use through 70 days (10 weeks) gestation 1, 2
- No clinically meaningful differences in outcomes between 57-63 days and 64-70 days 2
Pre-Treatment Requirements
Essential Assessments
- Confirm gestational age using ultrasonography or reliable menstrual history 1
- Ultrasonography is mandatory when:
- Negative pregnancy test within 2 weeks if using combination products containing NSAIDs 6
Provider Capabilities Required
- Ability to diagnose ectopic pregnancies 5
- Arrangements for surgical abortion backup in case of failure or emergencies 5
Expected Effects and Management
Normal Course
- Cramping and bleeding are expected therapeutic effects 1
- Average bleeding duration: 9-16 days 1
- Half of patients pass the pregnancy within hours after misoprostol administration 5
Side Effect Management
- Low-grade fever and gastrointestinal symptoms (nausea, diarrhea) are common with misoprostol 1
- Treat with NSAIDs or antiemetics as needed 1
- Warmth or chills occur more frequently with simultaneous dosing 4
Follow-Up and Confirmation
Timing
- Follow-up evaluation at 7±1 days after treatment initiation 4
- Additional contact at approximately 5 weeks 4
Confirmation Methods
- Transvaginal ultrasonography 4
- Serial quantitative beta-hCG levels 1
- Urine pregnancy testing 1
- Clinical history assessment 1
Management of Incomplete Abortion
- Offer second dose of misoprostol if abortion has not occurred 4
- Re-evaluate in approximately 1 week 4
Complications and Failure Rates
Efficacy
- Complete abortion rate: 95-97% with standard regimen 4
- Treatment failure defined as need for suction aspiration for any indication 4
Rare Complications
- Ongoing pregnancy 1
- Infection 1
- Hemorrhage (2-10% may require surgical intervention) 5
- Undiagnosed ectopic pregnancy 1
- Need for unplanned uterine aspiration 1
Critical Safety Considerations
Absolute Contraindications
Important Warnings
- Distinguish expected bleeding (average 14 days) from hemorrhage requiring intervention 5
- State requirements may mandate examination of expelled tissue—verify local regulations 5
- Medical abortion does not impact future fertility 7
- Abortion procedures are statistically safer than carrying pregnancy to term 7
Counseling Requirements
- Patients must receive both oral and written warnings about the medications 6
- Advise not to share medication with others 6
- Discuss expected bleeding patterns and when to seek emergency care 5
Clinical Setting
Medical abortion can be safely provided in ambulatory settings without special equipment or on-site emergency services, making it accessible through primary care and general internal medicine practices 3.