Bibliographic information
GuidelineMedical management of abortion
Year of Publication2018
Issuing InstitutionWorld Health Organization
Recommendation
Maintained
Originally developed
Medical management for intrauterine fetal demise at ≥ 14 to ≤ 28 weeks of gestation. For the misoprostol-only regimen, we suggest the use of repeat doses of 400 μg misoprostol administered sublingually every 4–6 hours
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- 1.In this guideline, duration of pregnancy (gestation) is the size of the uterus, estimated in weeks, based on clinical examination, that corresponds to a pregnant uterus of the same gestational age dated by last menstrual period (LMP).
- 2.Combination regimen is recommended because it is more effective.
- 3.Repeat doses of misoprostol can be considered when needed to achieve success of the abortion process. In this guideline we do not provide a maximum number of doses of misoprostol. Health-care providers should use caution and clinical judgement to decide the maximum number of doses of misoprostol in pregnant individuals with prior uterine incision. Uterine rupture is a rare complication; clinical judgement and health system preparedness for emergency management of uterine rupture must be considered with advanced gestational age
- 4.Data related to gestational ages over 24 weeks of gestation were more limited.
- 5.The use of a loading dose of misoprostol is not necessary. There is no advantage to the use of moistened over dry misoprostol.
- 6.This is a new recommendation
Also Featured In
This recommendation also appears in the following guidelines:
Guideline
Abortion care guideline
Year2022
InstitutionWHO
Guideline
Abortion care guideline, 2nd ed
Year2024
InstitutionWorld Health Organization