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Women, Incomplete Abortion
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► WHO 2018, Society of Family Planning 2023
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–Offer surgical or medical management vs. watchful waiting.
–If patient < 13-wk gestation elects medical management, give misoprostol 600 mcg orally or 400 mcg sublingually. Do not use vaginal misoprostol.
–If patient ≥ 13-wk gestation elects medical management, give repeated doses of misoprostol 400 mcg every 3 h sublingually, vaginally, or buccally.
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Women, Intrauterine Fetal Demise, 14–28-wk Gestation
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–Offer surgical or medical management vs. watchful waiting.
–If patient elects medical management, give 200-mg mifepristone1 orally; 1–2 d later, give 400-mcg misoprostol sublingually or vaginally, and repeat every 4–6 h. Complete abortion expected at 24–48 h. If mifepristone is not available or not preferred by the patient, give misoprostol 400 mcg every 4–6 h as the initial treatment.
–Adjunctive osmotic dilators are of limited benefit and usually only effective at 24 and 0/7 wk of gestation and past and used in combination with misoprostol.
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► WHO 2018, ACOG/SFP 2020
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–Options include vacuum aspiration (manual or electric), dilation, and evacuation or medical management.
–For medical abortion, give mifepristone 200 mg once as initial dose. At least 24 h later, give misoprostol 800 mcg vaginally, sublingually, or buccally (WHO: If ≥12-wk gestation, give 400 mcg). Alternative regimen 24 h after mifepristone, give misoprostol 400 mcg vaginally, buccally, or sublingually q3 h × 4 doses between 14.0 and 23.6 GA. (Contraception. 2024)
–If mifepristone is not available, use misoprostol monotherapy (800 mcg, repeat q3 h up to 3 doses).
–Offer NSAIDs for pain management. (ACOG/SFP)
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–Contraception. 2024;129.
–Medical Management of Abortion. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO.
–Obstet Gynecol. 2020;136.
–Society of Family Planning. Clinical Recommendation (Society for Maternal Fetal Medicine): Medication Abortion. 2023.
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