A woman took mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally for a pregnancy at 8 weeks. At follow-up 2 weeks later she feels well, but transvaginal ultrasound shows a gestational sac with a fetus measuring crown-rump length 22 mm and clear cardiac activity. What is the appropriate management?
- A Repeat the same mifepristone and misoprostol course
- B Suction evacuation of the uterus ✓
- C Give a further dose of misoprostol alone and recheck in 1 week
- D Expectant management with weekly scans until abortion occurs
Correct answer: B. Suction evacuation of the uterus
Explanation
An ongoing viable pregnancy after a complete mifepristone-misoprostol regimen is a recognized failure occurring in roughly 1 percent of cases. Because continued exposure to mifepristone may be theoretically teratogenic, the accepted practice is surgical evacuation by vacuum aspiration rather than repeating medical therapy. Expectant management is inappropriate with documented cardiac activity, and repeating misoprostol alone has poor success rates once a continuing pregnancy is confirmed.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.