A patient at 9 weeks of gestation requests medical abortion. She has no contraindications. According to current WHO 2022 guidelines for first-trimester medical abortion, what is the recommended regimen?
- A Mifepristone 200 mg oral followed by misoprostol 800 mcg vaginal/sublingual at 24–48 hours ✓
- B Mifepristone 600 mg oral followed by misoprostol 400 mcg oral at 36–48 hours
- C Misoprostol 800 mcg sublingual alone every 3 hours for up to 3 doses
- D Mifepristone 200 mg oral followed by misoprostol 400 mcg sublingual at 24 hours
Explanation
WHO 2022 Abortion Care Guidelines recommend mifepristone 200 mg orally (equivalent efficacy to 600 mg with better tolerability) followed 24–48 hours later by misoprostol 800 mcg administered vaginally, sublingually, or buccally for first-trimester medical abortion up to 12 weeks. This combination achieves complete abortion in >95% of cases. Mifepristone 600 mg (B) is the older dosing — 200 mg is equally effective with fewer side effects. Misoprostol alone (C) is less effective (75–90%) and used only when mifepristone is unavailable. Option D (400 mcg sublingual) is a lower dose and may be less effective beyond 7–8 weeks, though some protocols use this for ≤7 weeks.
Reference: Williams Obstetrics, 26th ed.
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