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Day 1 (Clinic): A clinician counsels the woman, takes a medical history and performs an exam and lab tests. The woman takes the mifepristone orally, either in the clinic or later at home. She is given misoprostol to administer at home.
Day 2-4 (Home): Misoprostol is self-administered bucally (in the cheek), sublingually (under the tongue), or vaginally at home. Nearly two thirds of women will have a complete abortion within four hours of the misoprostol administration; 90% of women will have a complete abortion within 24 hours of misoprostol administration.
Day 7-14 (Clinic): The woman returns to the clinic for follow-up and a clinician assesses for the completion of the abortion. If the abortion is incomplete (2%-5% of cases), the clinician will discuss treatment options with the woman. These options include waiting and re-evaluating, administering additional misoprostol, or performing an aspiration abortion.
Increasingly, women are given the option of returning to clinic for follow-up only if they experience severe side effects, suspect an ongoing pregnancy or incomplete abortion, or have evidence of other complications. Thus in many settings a follow-up clinic visit is not required. |
Day 1 (Clinic): A clinician counsels the woman, takes a medical history and performs an exam and lab tests. Methotrexate is administered either orally or intramuscularly and the woman is given misoprostol to administer at home.
Day 3-7 (Home): Misoprostol is self-administered orally or vaginally at home.
Day 8 (Clinic): A clinician performs a vaginal ultrasound to determine if the abortion is complete. Approximately 75% of women will have had a complete abortion and no further visits are required.
If the abortion is incomplete and no cardiac activity is detected on ultrasound, the woman is given additional misoprostol and returns to the clinic on Day 28-45. Approximately 15%-20% of women will complete the abortion process over the next three weeks.
If cardiac activity is detected, additional misoprostol is given and the woman returns on Day 15.
Day 15 (Clinic, if necessary): The patient is assessed for continued pregnancy. If cardiac activity is detected, an aspiration termination is performed. If no cardiac activity is detected, the woman is asked to return in three weeks.
Day 28-45 (Clinic, if necessary): The patient is assessed for continued pregnancy. If the abortion is incomplete (5% of cases), an aspiration termination is performed.
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A number of different protocols for the administration of misoprostol for early pregnancy termination have been investigated. The best available evidence suggests that the most effective regimen for the use of misoprostol alone is:
Day 1-2 (Home): The woman self-administers 800 micrograms of misoprostol either buccally (in the cheek) or sublingually (under the tongue) or vaginally. After 3-12 hours the woman takes a second 800 microgram dose through the same route. After another 3-12 hours the woman takes a third 800 microgram dose through the same route. In 75%-85% of cases, the woman will have a complete abortion within 1-2 weeks.
Day 7-14 (home/clinic): Women are encouraged to go to a clinic to confirm that the abortion is complete. However, if a woman is confident that the abortion was successful and she has not experienced severe side effects or complications this may not be necessary. In the 15%-25% of cases where the abortion is incomplete or the pregnancy is ongoing, the woman is encouraged to speak with a clinician about her treatment options. These include taking an dose of misoprostol (800 micrograms administered bucally, sublingually, or vaginally) or having an aspiration abortion. |
