A woman at 8 weeks gestation opts for medical abortion. She receives mifepristone 200 mg orally, followed 24–48 hours later by misoprostol. Regarding misoprostol administration, which route has the highest efficacy with fewest GI side effects for this gestation?

• A Oral misoprostol 800 mcg
• B Sublingual misoprostol 800 mcg
• C Vaginal misoprostol 800 mcg
• D Buccal misoprostol 800 mcg ✓

Explanation

WHO 2022 guidelines and Cochrane evidence for early medical abortion (up to 10 weeks) recommend buccal misoprostol 800 mcg (placed between cheek and gum) 24–48 hours after mifepristone. Buccal route achieves high bioavailability (~72%) similar to vaginal, better than oral (~12%), with fewer GI side effects (nausea, vomiting, diarrhoea) compared to sublingual, and avoids the acceptability concerns of vaginal self-administration. Efficacy rates > 95% are achieved with buccal route.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.