Remarks:

• The decision about the mode of management (expectant, medical or surgical) of missed abortion should be based on the individual’s clinical condition and preference for treatment.
• Expectant management can be offered as an option on the condition that the woman, girl or other pregnant person is informed of the longer time for expulsion of the pregnancy tissue and the increased risk of incomplete emptying of the uterus.
• Pregnancy tissue should be treated in the same way as other biological material unless the individual expresses a desire for it to be managed otherwise. * The minimum recommended interval between use of mifepristone and misoprostol is 24 hours. ǂ If using the alternative regimen (misoprostol alone), it should be noted that at gestational ages ≥ 9 weeks, evidence shows that repeat dosing of misoprostol is more effective to achieve success of the abortion process. In this guideline we do not provide a maximum number of doses of misoprostol.

KEY HUMAN RIGHTS CONSIDERATIONS RELEVANT TO MANAGEMENT OF MISSED ABORTION

• Everyone has a right to privacy and confidentiality in sexual and reproductive health (SRH) care.
• Abortion regulation should be human rights and evidence based.
• States must ensure adequate access to essential medicines in an affordable and nondiscriminatory manner.
• Everyone has the right to scientific progress and right to health, which requires the availability and accessibility, acceptability, and quality of medical abortion. This means that States should ensure access to abortion medicines, and that evidence-based standards and guidelines for the provision and delivery of SRH services, are (i) in place and (ii) routinely updated to incorporate medical advancements.