<13 Weeks’ Gestation

Pregnancy Termination¹

800 ?g sublingual administration every 3 hours

or vaginal administration / buccal every 3-12 hours (2–3 doses)

Missed Abortion²

800 ?g vaginal administration every 3 hours (x2)

or 600 ?g sublingual administration every 3 hours (x2)

Incomplete Abortion^2,3,4

600 ?g oral administration (x1)

or 400 ?g sublingual administration (x1)

or 400-800 ?g vaginal administration (x1)

Cervical Preparation for Surgical Abortion

400 ?g sublingual administration 1 hour before procedure

or vaginal administration 3 hours before procedure

13–26 Weeks’ Gestation

Pregnancy Termination^1,5,6

13–24 weeks: 400 ?g vaginal / sublingual / buccal administration every 3 hours

25–26 weeks: 200 ?g vaginal / sublingual / buccal administration every 4 hours

Foetal Death^1,5,6

200 ?g vaginal / sublingual / buccal administration every 4–6 hours

Inevitable Abortion^2,3,5,6,7

200 ?g vaginal / sublingual / buccal administration every 6 hours

Cervical Preparation for Surgical Abortion

13–19 weeks: 400 ?g vaginal administration 3-4 hours before procedure

>19 weeks: needs to be combined with other modalities

>26 Weeks’ Gestation8

Pregnancy Termination^1,5,9

27–28 weeks: 200 ?g vaginal / sublingual / buccal administration every 4 hours

>28 weeks: 100 ?g vaginal / sublingual / buccal administration every 6 hours

Foetal Death^2,9

27–28 weeks: 100 ?g vaginal / sublingual / buccal administration every 4 hours

>28 weeks: 25 ?g vaginal administration every 6 hours

or 25 ?g oral administration every 2 hours

Induction of Labour^2,9

25 ?g vaginal administration every 6 hours

or 25 ?g oral administration every 2 hours

Postpartum Use

Postpartum Haemorrhage (PPH) Prophylaxis^2,10

600 ?g oral administration (x1)

or PPH Secondary Prevention¹¹ (approx. ≥350ml blood loss)

800 ?g sublingual administration (x1)

PPH Treatment^2,10

800 ?g sublingual administration (x1)

 

¹ If mifepristone is available (preferable), follow the regimen prescribed for mifepristone + misoprostol

² Included in the WHO Model List of Essential Medicines

³ For incomplete/inevitable abortion women should be treated based on their uterine size rather than last menstrual period (LMP) dating

⁴ Leave to take effect over 1–2 weeks unless excessive bleeding or infection

⁵ An additional dose can be offered if the placenta has not been expelled 30 minutes after foetal expulsion

⁶ Several studies limited dosing to 5 times; most women have complete expulsion before use of 5 doses, but other studies continued beyond 5 and achieved a higher total success rate with no safety issues

⁷ Including ruptured membranes where delivery indicated

⁸ Follow local protocol if previous caesarean or transmural uterine scar

⁹ If only 200 ?g tablets are available, smaller doses can be made by dissolving in water

¹⁰ Where oxytocin is not available or storage conditions are inadequate

¹¹ Option for community based programs

Int J Gynaecol Obstet. 2017;138(3):363-366.