In first-trimester medical abortion using mifepristone-misoprostol, if the patient declines mifepristone, which misoprostol-alone regimen is considered acceptable by WHO for termination up to 12 weeks?

• A Misoprostol 400 mcg sublingual every 3 hours for 3 doses
• B Misoprostol 800 mcg sublingual every 3 hours for a maximum of 3 doses ✓
• C Misoprostol 200 mcg oral once only
• D Misoprostol 200 mcg vaginally once followed by oxytocin infusion

Explanation

WHO 2022 guidelines recommend misoprostol 800 mcg sublingually every 3 hours for up to 3 doses as the misoprostol-alone regimen for medical abortion up to 12 weeks when mifepristone is unavailable. Sublingual route achieves higher bioavailability than oral misoprostol. The combined regimen (mifepristone 200 mg oral followed 24–48 hours later by misoprostol 800 mcg) remains the preferred regimen with higher efficacy (~95%).

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

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Written and medically reviewed by the StethoPrep medical team.