If expulsion has not occurred within 24 hours, a second dose (4 tablets of 200 micrograms) should be taken. Women can choose come back in consultation to take the misoprostol rather than taking it home. In the vast majority of cases this treatment is successful. – Misoprostol is taken at home 1 to 2 days later (4 tablets of 200 micrograms for the first dose). Bleeding and cramping are expected to start within 3 hours. The woman can choose to take all medications at home. – Mifepristone is usually given under direct observation but it is not mandatory. A single visit is organized to provide information and counselling on ToP and the medication used for that purpose as well as on contraception and the specific method chosen by the patient. – Medication abortion is performed on an outpatient basis. The interval between each dose of metoclopramide should be at least 6 hours. – In the event of nausea/vomiting (not routinely): metoclopramide PO: 5 mg per dose for women 60 kg. – Depending on the patient's specific constraints, mifepristone and misoprostol can be taken simultaneously. – All these doses may be used in adults and adolescents over 12 years. Use one of these 2 drugs alone if ibuprofen is contra-indicated. 240 mg daily) or tramadol PO: 50 to 100 mg every 6 hours (max. If needed, add: codeine PO: 30 to 60 mg every 6 hours (max.
2400 mg daily) start with misoprostol and continue as needed after expulsion, up to 3 days max.
If mifepristone is not available or contra-indicated: give misoprostol alone as above.Īn analgesic or a combination of analgesics: IPAS. Clinical Updates in Reproductive Health. Misoprostol sublingually or vaginally: 400 micrograms every 3 hours until foetal and placental expulsion Citation 2. Misoprostol sublingually or vaginally: 800 micrograms every 3 hours (even if bleeding starts after the first or second dose) max. If mifepristone is not available or contra-indicated: If expulsion has not occurred within 24 hours, give a second dose of 800 micrograms of misoprostol. Misoprostol sublingually or vaginally: 800 micrograms Citation 1. Note: mifepristone and misoprostol are not indicated for the termination of an ectopic or molar pregnancy. From 13 to 22 weeks LMP: admit patient for observation reduce the dose of misoprostol to 200 micrograms respect a minimum interval of one day between mifepristone and misoprostol.Preferably use the combined regimen mifepristone + misoprostol, as fewer numbers of misoprostol doses are required.– In case of 2 or more previous uterine scars, given the risk of uterine rupture: – Chronic adrenal failure and severe uncontrolled asthma: use misoprostol alone. – Coagulation disorders: MVA is preferred, if medication abortion is performed it must be carried out under observation. The combination mifepristone + misoprostol is more effective than misoprostol used alone and reduces the number of misoprostol doses needed, thus reducing its adverse effects. Misoprostol, however, is an effective and safe option even when used alone.
The risk of severe complications is less than 0.1% and the success rate is 97-98%. Medication abortion is a safe and effective method of ToP.
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