Best practice in comprehensive abortion care

Question 1

14 weeks abortion where to happen

Answer 1

“At 14 weeks of gestation or more, medical abortion should be undertaken in a medical facility.

Question 2

mifepristone advantages

Answer 2

1 - shortens induction–abortion interval,
2 - reduces side effects and
3 - decreases rate of ongoing pregnancy.

Question 3

If mifepristone available, regimen with misoprostol

Answer 3

1 - mifepristone 200 mg orally, followed 12–48 hours later by misoprostol 800 mcg vaginally, followed by misoprostol 400 mcg orally or vaginally every 3 hours until abortion occurs;

2 - if > 24 hours abortion not occur, mifepristone can be repeated 3 hours after last dose of misoprostol, and 12 hours later misoprostol may be recommenced

Question 4

where mifepristone is not available

Answer 4

misoprostol 800 mcg followed by 400 mcg every 3 hours until abortion occurs.

Question 5

ACOG, Second-trimester abortion. 2013.

“Regimens for second-trimester medical abortion

mifepristone is available

Answer 5

• Mifepristone, 200 mg, administered orally, followed in 24-48 hours by Misoprostol, 800 mcg, PV, followed by 400 mcg administered vaginally or sublingually or buccally, every 3 hours for up to a maximum of five doses.

Question 6

ACOG, Second-trimester abortion. 2013.
“Regimens for second-trimester medical abortion
mifepristone is not available

Answer 6

2 - If mifepristone is not available:

Misoprostol, 400 mcg, administered vaginally or sublingually every 3 hours for up to five doses.

Question 7

which route for misoprostol id superior

Answer 7

Vaginal dosage is superior to sublingual dosage for nulliparous women.

Question 8

Dose and route of misoprostol superior

Answer 8

A vaginal loading dose of 600-800 mcg of misoprostol followed by 400 mcg administered vaginally or sublingually every 3 hours may be more effective.

Question 9

”* If the abortion is not complete after five doses

Society of Family Planning. Labor induction abortion in the second trimester. 2011. (Borgatta)

Answer 9

woman may be allowed to rest for 12 hours before starting the cycle again.

Question 10

Dosing of misoprostol superior

.”RCOG. Care of women requesting induced abortion. 2011.

Answer 10

“Misoprostol alone is best used vaginally or sublingually, and doses of 400 mcg are generally superior to 200 mcg or less.
Dosing every 3 h is superior to less frequent dosing, although intervals of up to 12 h are effective when using higher doses (600 or 800 mcg) of misoprostol

Question 11

regimen is recommended for medical abortion between 13 and 24 weeks of gestation:

Answer 11

Mifepristone 200 mg orally, followed 36–48 hours later by misoprostol 800 micrograms vaginally, then misoprostol 400 micrograms orally or vaginally, 3-hourly, to a maximum of four further doses.
- If abortion does not occur, mifepristone can be repeated 3 hours after the last dose of misoprostol and 12 hours later misoprostol may be recommenced.”