Mifepristone + Misoprostol regimen

• Medical TOP (<24/40)
• Missed miscarriage
• IUFD induction

Mifepristone: anti-progesterone → decidual breakdown & cervical softening. Misoprostol 24–48 h later: PGE₁ → contractions.

• Mife 200 mg PO
• Wait 24–48 h
• Miso 800 µg vaginal/buccal
• Repeat miso q3h if needed

<10/40

Mife 200 mg → miso 800 µg 24–48 h later

10–24/40

Mife → miso 400 µg q3h

Cervical priming

Miso 400 µg 3 h pre-procedure

• AbsoluteEctopic pregnancy
• AbsoluteChronic adrenal failure (mife)
• AbsoluteIUD in situ (remove first)

• Cramping
• Bleeding
• Nausea / diarrhoea (miso)
• Fever / chills (miso)
• Incomplete TOP 2–5%

• • Used to end pregnancy / expel non-viable tissue.
• • Avoid in viable pregnancy you want to continue.

• NSAIDs

  OK

  Do NOT reduce miso efficacy — give for pain

• 💡 Anti-D if Rh-negative ≥10/40.
• 💡 Confirm completion: USS or β-hCG drop ≥80% at 2 weeks.