A woman at 8 weeks of gestation requests medical abortion. Which of the following is an absolute contraindication to the mifepristone and misoprostol regimen?

• A Previous two lower segment caesarean deliveries
• B Mild intermittent asthma using an inhaler
• C Chronic adrenal cortical insufficiency ✓
• D Haemoglobin of 10 g/dL

Explanation

Chronic adrenal insufficiency is an absolute contraindication to mifepristone because the drug competitively blocks glucocorticoid receptors as well as progesterone receptors. A woman with adrenal failure cannot mount a cortisol response and risks an acute Addisonian crisis. Prior caesarean delivery is explicitly not a contraindication to medical abortion, including at later gestations. Mild controlled asthma does not preclude the regimen, and a haemoglobin of 10 g/dL is acceptable because blood loss in first-trimester medical abortion approximates that of a spontaneous miscarriage.

Reference: WHO Abortion Care Guideline, 2022 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.