A 24-year-old woman requests medical abortion at 8 weeks gestation. She has an intrauterine pregnancy confirmed on ultrasound. Which regimen is WHO-recommended as first-line for medical abortion at this gestation?

• A Misoprostol 800 µg vaginally alone
• B Methotrexate 50 mg/m² IM followed by misoprostol
• C Mifepristone 600 mg followed immediately by misoprostol 400 µg
• D Mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 µg ✓

Explanation

WHO recommends the combination regimen: mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 µg (buccal, sublingual, or vaginal) for medical abortion up to 12 weeks. This combination has >95% complete abortion rate. Misoprostol alone is less effective (75–85%). The 200 mg mifepristone dose is as effective as 600 mg with fewer side effects. Methotrexate-misoprostol is used for ectopic pregnancy, not routine medical abortion.

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

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