Safe abortion:

Remarks
y The regimen for medical abortion between 9
and 12 weeks of gestation is an area of ongoing
research; this recommendation is likely to be
affected as studies are completed.
y The quality of evidence based on one randomized
controlled trial and one observational study is low.
recommendation 4: medical abortion up to
gestational age 12 weeks (84 days) where
mifepristone is not available
The recommended method of medical abortion
where mifepristone is not available is 800 μg of misoprostol
administered by vaginal or sublingual routes.
Up to three repeat doses of 800 μg can be administered
at intervals of at least 3 hours, but for no longer
than 12 hours.
(Strength of recommendation: strong)
Remarks
y Sublingual misoprostol is associated with higher
rates of side-effects than vaginal administration.
In nulliparous women, the sublingual route is
also less efficacious when intervals greater than
3 hours between repeat doses are used.
y The quality of the evidence based on one randomized
controlled trial is high.
y Mifepristone with misoprostol is more effective
than misoprostol used alone, and is associated
with fewer side-effects. Methotrexate combined
with misoprostol, a regimen used in some areas
but not recommended by WHO, is less effective
than mifepristone with misoprostol, but is more
effective than misoprostol used alone.
recommendation 5: methods of abortion after
gestational age 12 to 14 weeks
(84 to 98 days)
Dilatation and evacuation (D&E) and medical methods
(mifepristone and misoprostol; misoprostol
alone) are both recommended methods for abortion
for gestations over 12 to 14 weeks. Facilities should
offer at least one, and preferably both, methods if
possible, depending on provider experience and the
availability of training.
(Strength of recommendation: strong)
Remarks
y Evidence for this question is limited by women’s
willingness to be randomized in clinical trials
between surgical and medical methods of abortion.
y The quality of the evidence based on randomized
controlled trials is low.
y A woman’s choice of abortion method may be
limited or not applicable if she has medical contraindications
to one of the methods.
recommendation 6: medical abortion after
gestational age 12 weeks (84 days)
The recommended method for medical abortion is
200 mg mifepristone administered orally followed
36 to 48 hours later by repeated doses of
misoprostol.
(Strength of recommendation: strong)
– With gestations between 12 and 24 weeks, the
initial misoprostol dose following oral mifepristone
administration may be either 800 μg
administered vaginally or 400 μg administered
orally. Subsequent misoprostol doses should
be 400 μg, administered either vaginally or sublingually,
every 3 hours up to four further doses.
Safe abortion: technical and policy guidance for health systems 115