Clinical Updates in Reproductive Health

Summary of recommended medical abortion regimens

Last reviewed: April 21, 2020

Medical abortion with mifepristone and misoprostol

  • Up to 10 weeks gestation (70 days since last menstrual period (LMP)):
    • Mifepristone 200mg orally
    • Misoprostol 800mcg buccally, sublingually or vaginally 1-2 days after mifepristone
  • 10-13 weeks gestation:
    • Mifepristone 200mg orally
    • Misoprostol 600mcg sublingually or 800mcg vaginally 1-2 days after mifepristone, then misoprostol 400mcg sublingually or vaginally every three hours until expulsion
    • Alternatively, mifepristone 200mg orally followed 1-2 days later by misoprostol 800mcg buccally, sublingually or vaginally may be used. The dose of misoprostol may be repeated to achieve abortion success.
  • At or after 13 weeks gestation (13-24 weeks):
    • Mifepristone 200mg orally
    • Misoprostol 400mcg buccally, sublingually or vaginally 1-2 days after mifepristone, then every three hours until fetal and placental expulsion
    • If the woman is stable and it is convenient for her to do so, providers should allow her at least four hours after fetal expulsion to expel the placenta.

Medical abortion with misoprostol only

  • Before 13 weeks gestation:
    • Misoprostol 800mcg buccally, sublingually or vaginally every 3 hours until  expulsion
  • At or after 13 weeks gestation:
    • Misoprostol 400mcg sublingually or vaginally every 3 hours until fetal and placental expulsion. Vaginal dosing is more effective than sublingual dosing for nulliparous women
    • If the woman is stable and it is convenient for her to do so, providers should allow her at least four hours after fetal expulsion to expel the placenta

Medical treatment for incomplete abortion, missed abortion or intrauterine fetal demise (postabortion care)

  • Less than 13 weeks uterine size:
    • Incomplete abortion:
      • Misoprostol 600mcg orally in a single dose or 400mcg in a single dose sublingually or, in the absence of vaginal bleeding, vaginally
    • Missed abortion:
      • Misoprostol 600mcg sublingually or, in the absence of vaginal bleeding, 800 mcg vaginally every 3 hours until expulsion (generally 1-3 doses)
      • Where available, add pretreatment with mifepristone 200 mg orally 1-2 days before misoprostol
  • 13 weeks or larger uterine size:
    • Incomplete abortion:
      • Misoprostol 400mcg buccally, sublingually or, in the absence of vaginal bleeding, vaginally every three hours until expulsion
    • Intrauterine fetal demise (up to 24 weeks)
      • Misoprostol 400 mcg sublingually or, in the absence of vaginal bleeding, vaginally every 4-6 hours until expulsion
      • Where available, add pretreatment with mifepristone 200mg orally 1-2 days before misoprostol.

Resources

Protocols for medical abortion (dosage card)

Mifepristone/Misoprostol Gestational Dating Wheels

Misoprostol-only Gestational Dating Wheels