Misoprostol-only regimens (WHO and FIGO guidelines) for pregnancy termination

WHO Guideline (2022)^[1]		FIGO Guideline (2017)^[2]
Gestational age	Misoprostol dosing	Gestational age	Misoprostol dosing
<12 weeks	Buccal, intravaginal*, sublingual: 800 mcg^¶	<13 weeks	Sublingual: 800 mcg every 3 hours for 2 to 3 doses or Intravaginal*, buccal: 800 mcg every 3 to 12 hours for 2 to 3 doses
≥12 weeks	Buccal, intravaginal*, sublingual: 400 mcg every 3 hours^Δ	13 to 24 weeks	Intravaginal*, sublingual, buccal: 400 mcg every 3 hours^Δ^◊
		25 to 28 weeks	Intravaginal*, sublingual, buccal: 200 mcg every 4 hours^Δ^◊
		>28 weeks	Intravaginal*, sublingual, buccal: 100 mcg every 6 hours^Δ^◊

Both guidelines recommend a combination regimen of mifepristone followed by misoprostol when possible because it is more effective. Misoprostol should be used with caution in individuals with prior uterine incision, particularly at advanced gestational ages.

WHO: World Health Organization; FIGO: International Federation of Gynecology and Obstetrics.

* Avoid intravaginal administration if bleeding and/or signs of infection.

¶ Repeat doses can be used when needed; this guideline does not provide a dosing interval or maximum number of doses.

Δ Repeat doses can be used when needed; this guideline does not provide a maximum number of doses.

◊ An additional dose can be offered if the placenta has not been expelled 30 minutes after fetal expulsion.

References:

Abortion care guideline, World Health Organization 2022. Available at: https://apps.who.int/iris/handle/10665/349316 (Accessed on November 10, 2022).
Morris JL, Winikoff B, Dabash R, et al. FIGO's updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynaecol Obstet 2017; 138:363.

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Misoprostol-only regimens (WHO and FIGO guidelines) for pregnancy termination