For medical abortion up to 63 days (9 weeks) gestation, the WHO-recommended regimen is mifepristone 200 mg followed by misoprostol. What is the correct timing and route of misoprostol administration?

• A Misoprostol 400 µg sublingual immediately after mifepristone
• B Misoprostol 800 µg sublingual/buccal/vaginal 24–48 hours after mifepristone ✓
• C Misoprostol 200 µg oral every 3 hours for 3 doses, 24 hours after mifepristone
• D Misoprostol 1000 µg vaginal 72 hours after mifepristone

Explanation

The WHO-recommended medical abortion regimen for ≤63 days consists of mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 µg administered sublingually, buccally, or vaginally. Sublingual and buccal routes have better efficacy than oral for misoprostol due to higher bioavailability. The 24–48 hour interval between mifepristone and misoprostol is critical for optimal efficacy (>95% complete abortion rate).

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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