A woman at 9 weeks of gestation requests medical abortion. According to WHO 2022 abortion care guidelines, the recommended mifepristone-misoprostol regimen for medical management of first-trimester pregnancy up to 12 weeks is:
- A Mifepristone 200 mg orally, followed 24–48 hours later by misoprostol 400 µg sublingual
- B Mifepristone 600 mg orally, followed 36–48 hours later by misoprostol 800 µg vaginal
- C Mifepristone 200 mg orally, followed 24–48 hours later by misoprostol 800 µg buccal, sublingual or vaginal ✓
- D Misoprostol 600 µg sublingual alone every 3 hours for three doses
Explanation
WHO 2022 abortion guidelines recommend mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 µg administered buccally, sublingually, or vaginally for medical abortion up to 12 weeks. The 600 mg dose of mifepristone (option B) is not superior to 200 mg and is not recommended. Sublingual 400 µg misoprostol (option A) is the dose used ≤9 weeks in some protocols but 800 µg is the standard dose. Misoprostol alone (option D) is a second-line option only when mifepristone is unavailable. The 24–48 hour interval is now recommended (not 36–48 hours specifically), though 24 hours is acceptable.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.