What is the recommended dosing and administration schedule of mifepristone followed by misoprostol for medical termination of an intra‑uterine pregnancy up to 10 weeks in a healthy woman without contraindications?

Medical Termination of Pregnancy: Mifepristone and Misoprostol Administration

For medical termination of intrauterine pregnancy up to 10 weeks (70 days) gestation, administer mifepristone 200 mg orally followed by misoprostol 800 mcg administered buccally or vaginally 24–48 hours later. 1, 2

Standard Dosing Protocol

Mifepristone Administration:

• Give 200 mg orally as a single dose 1, 2
• This can be administered in the office or clinic setting 2
• The American College of Obstetricians and Gynecologists recommends 200–600 mg, but 200 mg is the standard effective dose 1

Misoprostol Administration (24–48 hours after mifepristone):

• Administer 800 mcg either buccally or vaginally 2
• The patient can self-administer at home 24 hours after mifepristone 3
• Vaginal route is preferred for optimal efficacy 2, 3

Alternative Timing Option

• Simultaneous administration (mifepristone and misoprostol given at the same time) is equally effective up to 63 days gestation, with complete abortion rates of 95.1% 3
• This approach may increase gastrointestinal side effects (nausea, diarrhea, warmth/chills) compared to the 24-hour interval 3

Gestational Age Limits

• Up to 77 days (11 weeks) gestation for medication abortion 2
• Up to 63 days (9 weeks) for simultaneous administration regimen 3
• Efficacy remains high across this gestational age range without significant differences 3

Pre-Treatment Requirements

Confirm gestational age using:

• Ultrasonography when menstrual dating is uncertain 2
• Ultrasonography when risk factors for ectopic pregnancy exist 2
• Menstrual history alone is acceptable when dating is reliable and ectopic risk is low 2

Screen for absolute contraindications:

• Previous cesarean delivery (misoprostol carries risk of uterine rupture) 1, 4
• Confirmed or suspected ectopic pregnancy 2
• Severe comorbidities requiring management in experienced centers 1, 4

Medication review:

• Mifepristone is metabolized by CYP3A4; review all concomitant medications for drug-drug interactions 1

Expected Effects and Timeline

Bleeding and cramping:

• Cramping and bleeding are expected therapeutic effects 2
• Bleeding lasts an average of 9–16 days 2
• Most women abort within 24 hours of misoprostol administration 3

Side effects (primarily from misoprostol):

• Low-grade fever 2
• Gastrointestinal symptoms: nausea, vomiting, diarrhea 4, 2
• Manage with NSAIDs or antiemetics 2

Follow-Up Assessment

Timing:

• Return visit 7±1 days after initiating treatment 3
• Additional follow-up approximately 5 weeks after treatment 3

Confirmation of complete abortion using:

• Clinical history combined with serial quantitative beta-hCG levels 2
• Urine pregnancy testing 2
• Transvaginal ultrasonography 2, 3

Management of incomplete abortion:

• Offer second dose of misoprostol 800 mcg if gestational sac persists at first follow-up 3
• Return for re-evaluation in approximately 1 week 3
• Suction aspiration is performed if pregnancy remains viable or for clinical indications 3

Rare Complications

• Ongoing pregnancy 2
• Infection 2
• Hemorrhage 2
• Undiagnosed ectopic pregnancy 2
• Need for unplanned uterine aspiration (occurs in approximately 5% of cases) 2, 3

High-Risk Patient Considerations

For patients with severe comorbidities or previous cesarean delivery:

• Dilatation and evacuation remains the safest procedure and should be strongly considered 4
• High-risk patients require management in experienced centers with emergency support services 1, 4
• Surgical evacuation has lower risk of prolonged bleeding compared to medical termination 4