In early medical abortion (≤9 weeks), the standard regimen per WHO 2022 guidelines is mifepristone 200 mg followed by misoprostol. The recommended dose and route of misoprostol at 24–48 hours after mifepristone for gestations ≤12 weeks is:
- A 400 mcg sublingual or 400 mcg vaginal
- B 600 mcg oral (swallowed)
- C 800 mcg sublingual, buccal, or vaginal ✓
- D 1000 mcg rectal only
Explanation
WHO 2022 recommends mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 mcg administered sublingually, buccally, or vaginally for medical abortion up to 12 weeks. Sublingual administration achieves the fastest absorption with highest bioavailability (83%) but more systemic side effects (chills, fever); vaginal misoprostol is slower but has fewer GI side effects. Complete abortion rates are approximately 95–97% with this regimen at ≤9 weeks, decreasing with advancing gestation. The 400 mcg dose is insufficient for ≥7-week gestations. In settings where mifepristone is unavailable, misoprostol-alone regimens use 800 mcg vaginally/sublingually with lower complete abortion rates (~80%).
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.