Unwanted Kit — Mifepristone 200 mg + Misoprostol 200 mcg ×4

Indication

Dosing Regimen

Minimum interval between mifepristone and misoprostol: 24 hours (WHO Abortion Care Guidelines, p. 108). Standard clinical practice uses 36–48 hours.

Misoprostol Administration Routes

• Vaginal: Place all 4 tablets deep in the posterior fornix. Most effective, less nausea/diarrhea.
• Buccal: Place 2 tablets in each cheek pouch, hold for 30 min, then swallow remnants.
• Sublingual: Place under tongue for 30 min. Highest systemic absorption but more GI side effects.

What to Expect After

• Cramping & bleeding begin within 1–4 hours of misoprostol — this is the expulsion process.
• Heavy bleeding with clots is normal for the first few hours.
• Lighter bleeding may continue for 1–2 weeks.

Follow-Up

• A clinical review (ultrasound or serum β-hCG) is recommended 14 days after misoprostol to confirm complete abortion.
• If abortion is incomplete, a repeat dose of misoprostol or surgical evacuation may be needed.

Key Contraindications

• Gestational age > 7 weeks (for this kit's labeled use)
• Ectopic pregnancy (must be ruled out first)
• Chronic adrenal failure, inherited porphyria
• Long-term corticosteroid therapy
• Coagulopathy or anticoagulant use
• IUD in situ (must be removed first)

Common Side Effects

• Nausea, vomiting, diarrhea (especially sublingual route)
• Uterine cramping and pain (manage with NSAIDs like ibuprofen)
• Chills, low-grade fever (transient)

Note: This kit is a prescription medication (Rx). Use under medical supervision only.

Unwanted Kit at 4 Weeks of Pregnancy

Regimen

At 4 Weeks — What's Different Clinically

• Higher success rate — the earlier the gestation, the more effective medical abortion is. At ≤4 weeks, complete abortion rates approach 95–98%.
• Lighter bleeding compared to later gestations — expulsion is faster and less painful.
• Cramping is milder — less analgesic requirement typically.
• At very early gestation (< 4 weeks / < 28 days LMP), some guidelines note a slightly higher chance of failed abortion where the sac may not yet be visible on ultrasound, making it harder to confirm success — a follow-up β-hCG or ultrasound at 2 weeks is still essential.

Bottom Line

Same dose, same timing. Earlier gestation = higher efficacy and milder side effects. Confirm complete abortion at 2-week follow-up regardless of gestational age.