A 10-week missed abortion is diagnosed on ultrasound. The woman opts for medical management. The most effective regimen for medical management of first-trimester missed abortion is:

• A Misoprostol 800 µg vaginally as a single dose
• B Methotrexate 50 mg/m² IM followed by misoprostol
• C Oral misoprostol 400 µg every 3 hours for 3 doses
• D Mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 µg vaginally ✓

Explanation

Multiple RCTs and a Cochrane review confirm that mifepristone (200 mg orally) followed 24–48 hours later by misoprostol (800 µg vaginally or sublingual) achieves complete expulsion in 80–90% of cases of early pregnancy failure, superior to misoprostol alone (65–75%). Methotrexate is used for ectopic pregnancy management, not missed abortion. The combination regimen mirrors the regimen for induced abortion and is the most efficacious medical option for first-trimester fetal demise.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.