Several dosing schemes are efective, and some are shown in Table 18-7. Because of its greater e.cacy, mifepristonel misoprostol combinations are favored. Presently, for gestations up to 63 days, the most widely accepted regimen is mifepristone, 200 mg given orally on day 0 and followed in 24 to 48 hours by misoprostol 800 �g, administered by a vaginal, buccal, or sublingual route (American College of Obstetricians and Gynecologists, 2016c). Another earlier regimen used a 600-mg oral mifepristone dose followed in 48 hours by a 400-�g oral misoprostol dose (Spitz, 1998). If desired, mifepristone and misoprostol may be self-administered at home (Chong, 2015). At Planned Parenthood clinics, for irst-trimester medical abortion, doxycycline 100 mg is taken orally daily for 7 days and begins with abortifacient administration (Fjerstad, 2009). he woman is then discharged home and appointed to return in 1 to 2 weeks.
Symptoms following misoprostol are common within 3 hours and include vomiting, diarrhea, fever, and chills. Bleeding and cramping with medical termination typically is signiicantly worse than with menses. Thus, adequate analgesia, usually including a narcotic, is provided. If bleeding soaks two or more pads per hour for at least 2 hours, the woman is instructed to contact her provider to determine whether she needs to be seen .
At the follow-up appointment, routine postabortal sonographic examination is typically unnecessary (Clark, 2010). Instead, assessment of the clinical course along with bimanual pelvic examination is recommended. If sonography is indicated
TABLE 18-7. Various Regimens for Medical Termination of Pregnancy aMifepristone, 200-600 mg orally; followed in 24-48 hr by: bMisoprostol, 200-600 �g orally or 400-800 �g vaginally, buccally, or sublingually
Methotrexate/Misoprostol dMethotrexate, 50 mg/m2 BSA intramuscularly or orally; followed in 3-7 days by: eMisoprostol, 800 �g vaginally. Repeat if needed 1 week after methotrexate initially given
Mifepristone, 200 mg orally; followed in 24-48 hr byj
Misoprostol, 400 �g vaginally or buccally every 3 hr up to 5 doses
Misoprostol, 600-800 �g vaginally; followed by 400 �g vaginally or buccally every 3 hr up to 5 doses 50 units oxytocin in 500 mL of normal saline infused during 3 hr; then 1-hr diuresis (no oxytocin); then escalate sequentially in a similar fashion through 150,200,250, and finally 300 units oxytocin each in 500 mL normal saline aOoses of 200 versus 600 mg similarly effective. bOral route may be less effective and have more nausea and diarrhea. Sublingual route has more side effects than vaginal route.