Population: Women with incomplete abortion.

Organization

WHO 2018

Recommendations

–Offer surgical or medical management vs. watchful waiting.

–If patient <13-wk gestation elects medical management, give misoprostol 600 μg orally or 400 μg sublingually. Do not use vaginal misoprostol.

–If patient ≥13-wk gestation elects medical management, give repeated doses of misoprostol 400 μg every 3 h sublingually, vaginally, or buccally.

Population: Women with intrauterine fetal demise between 14- and 28-wk gestation.

Organization

WHO 2018

Recommendations

–Offer surgical or medical management vs. watchful waiting.

–If patient elects medical management, give 200-mg mifepristone¹ orally; 1–2 d later, give 400-μg misoprostol sublingually or vaginally, and repeat every 4–6 h. If mifepristone is not available or not preferred by the patient, give misoprostol 400 μg every 4–6 h as the initial treatment.

Population: Women who elect to induce an abortion.

Organizations

WHO 2018, ACOG/SFP 2020

Recommendations

–Options include vacuum aspiration (manual or electric), dilation, and evacuation or medical management.

–For medical abortion, give mifepristone¹ 200 mg once as initial dose. At least 24 h later, give misoprostol 800 μg vaginally, sublingually, or buccally (WHO: If ≥12-wk gestation, give 400 μg).

–If mifepristone is not available, use misoprostol monotherapy (800 mcg, repeat q 3 h up to 3 doses).

–Offer NSAIDs for pain management. (ACOG/SFP)

Sources

–Medical Management of Abortion. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO.

–Obstet Gynecol. 2020;136.