A woman presents at 9 weeks gestation requesting medical abortion. She is hemodynamically stable with no contraindications. The WHO-recommended regimen for medical abortion at this gestational age is:
- A Misoprostol 800 mcg vaginally as single dose
- B Methotrexate 50 mg/m² IM followed by misoprostol 48 hours later
- C Mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 mcg sublingually or vaginally ✓
- D Mifepristone 600 mg orally followed immediately by misoprostol 400 mcg orally
Correct answer: C. Mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 mcg sublingually or vaginally
Explanation
The WHO (2022 guidelines) and RCOG recommend mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 mcg (sublingual, buccal, or vaginal route) for medical abortion up to 12 weeks. This combined regimen achieves >95% complete abortion rates. Misoprostol alone is less effective than the combination. Mifepristone 600 mg is not more effective than 200 mg and is unnecessary. Methotrexate-misoprostol is used where mifepristone is unavailable.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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