Second trimester medical termination using mifepristone-misoprostol is planned at 16 weeks. The mifepristone 200 mg is given orally. After how many hours should vaginal/sublingual misoprostol be administered, and what is the standard dose?
- A After 36–48 hours: misoprostol 400 mcg sublingual or vaginal every 3 hours (max 5 doses) ✓
- B After 24 hours: misoprostol 800 mcg vaginally, then 400 mcg every 3 hours (max 5 doses)
- C After 12 hours: misoprostol 400 mcg sublingually every 4 hours until expulsion
- D After 48 hours: misoprostol 200 mcg vaginally every 6 hours for 48 hours
Correct answer: A. After 36–48 hours: misoprostol 400 mcg sublingual or vaginal every 3 hours (max 5 doses)
Explanation
WHO and RCOG protocols for second trimester medical abortion: mifepristone 200 mg orally followed 36–48 hours later by misoprostol 400 mcg vaginally or sublingually (sublingual has higher bioavailability but more systemic side effects) every 3 hours for up to 5 doses. The 36–48 hour interval allows maximal mifepristone-induced cervical softening and progesterone receptor blockade. A 24-hour interval is acceptable but 36–48 hours is standard for higher efficacy rates in the second trimester.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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