TERMINATION OF PREGNANCY

Therapeutic abortion is termination of pregnancy for medical indications

Method of Therapeutic Abortion

May be surgical or medical

Surgical:
  • After 12 weeks: MVA or EVA
  • In 13th–18th week, dilatation and evacuation (D&E) after cervical priming with misoprostrol 400μg for 3 hours.
  • D&E should only be performed by skilled and experienced doctors.

Medical:

In 13–22 weeks:

  • Give mifepristone 200mg orally, followed after 36–48 hours by misoprostrol 400μg orally every 3 hours for 5 doses.
  • Or misoprostrol 400μg orally every 3 hours for 5 doses.

Medication for therapeutic abortion

Option Gesta-tional age Mifepristone Day 1 Misoprostol Efficacy
Dose Route Timing
Recommended option Up to 9 weeks 200mg orally (one 200mg tablet) 800μg (four 200μg tablets) Bucally or sub lingually Day 3 95–98%
Other options Up to 9 weeks 200mg orally (one 200mg tablet) 800μg (four 200μg tablets) Vaginally Day 2 or 3 93–97%
200mg orally (one 200mg tablet) 800μg (four 200μg tablets) Repeat after +7 days if not aborted Vaginally 6–24 hours 95–98%
Up to 7 weeks 200mg orally (one 200mg tablet) 400μg (two 200μg tablets) Orally Day 2 or 3 89–93%

Sources: Ashok, 2002; Britton, 2007; Creinin, 2004; Middleton, 2005; Shannon, 2006; Tang,
2003; von Hertzen, 2003; WHO, 2000.