Prostaglandin termination of pregnancy

Medical abortion regimens using 200 mg oral mifepristone and misoprostol are effective and appropriate at any gestation (1).

Prostaglandins in the form of pessaries (gemeprost) were used historically , however, the use of misoprostol are recommended today.

• Recommended regimens are as follows:
  • at ≤49 days of gestation
    • 200 mg oral mifepristone followed 24–48 hours later by 400 micrograms of oral misoprostol
  • at ≤63 days of gestation
    • mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 micrograms (vaginal, buccal or sublingual)
    • for women at 50–63 days of gestation, if abortion has not occurred 4 hours after administration of misoprostol, a second dose of misoprostol 400 micrograms may be administered vaginally or orally (depending on preference and amount of bleeding)
  • between 9 and 13 weeks of gestation
    • mifepristone 200 mg orally followed 36–48 hours later by misoprostol 800 micrograms vaginally
    • maximum of four further doses of misoprostol 400 micrograms may be administered at 3-hourly intervals, vaginally or orally
  • between 13 and 24 weeks of gestation
    • mifepristone 200 mg orally, followed 36–48 hours later by misoprostol 800 micrograms vaginally, then misoprostol 400 micrograms orally or vaginally, 3-hourly, to a maximum of four further doses
    • if abortion does not occur, mifepristone can be repeated 3 hours after the last dose of misoprostol and 12 hours later misoprostol may be recommenced

Reference:

1. Royal college of obstetricians and gynaecologists (RCOG) 2011. The care of women requesting induced abortion. Evidence based clinical guideline number 7.