In medical management of missed abortion at 10 weeks using mifepristone + misoprostol, which mifepristone-to-misoprostol interval and misoprostol route have been shown in RCTs to maximize complete evacuation rates?

• A Mifepristone 600 mg orally; 36 hours later misoprostol 400 µg oral
• B Mifepristone 200 mg orally; 24–48 hours later misoprostol 800 µg vaginal in office
• C Mifepristone not required; misoprostol 800 µg vaginal alone is equally effective
• D Mifepristone 200 mg orally; 24–48 hours later misoprostol 800 µg sublingual ✓

Explanation

Evidence (Bracken et al., Cochrane reviews) supports mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 µg sublingually as the most effective combination for medical management of early pregnancy failure (missed abortion <13 weeks), with complete evacuation rates of 84–91%. The sublingual route provides faster absorption and higher bioavailability than vaginal when the cervix is closed, which is common in missed abortion. Mifepristone 200 mg is equally effective to 600 mg and is the WHO-recommended dose. Misoprostol alone (without mifepristone) has lower complete evacuation rates.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.