MTP Kit (Medical Termination of Pregnancy Kit)

Composition

• Mifepristone 200 mg - 1 tablet
• Misoprostol 200 mcg - 4 tablets (total 800 mcg)

Mechanism of Action

• An analog of the progestin norethindrone
• Selective progesterone receptor modulator (SPRM)
• Binds to the progesterone receptor with higher affinity than progesterone itself, but blocks its action
• Causes decidual breakdown and sensitizes the uterus to prostaglandins
• Also has some antiglucocorticoid activity

• Synthetic prostaglandin E1 analogue
• Stimulates uterine contractions and cervical ripening
• Acts synergistically with mifepristone for expulsion

1. Mifepristone blocks progesterone support of the pregnancy
2. Misoprostol causes uterine contractions to expel the products of conception

Approved Regimens

• Mifepristone 200 mg orally on Day 1
• Misoprostol 800 mcg buccally (or vaginally / sublingually) 24-48 hours later
• Approved up to 70 days (10 weeks) from the last menstrual period

• Mifepristone 600 mg on Day 1
• Misoprostol 400 mcg orally on Day 3 (This is less preferred; 200 mg mifepristone is equally effective)

Misoprostol Routes

Contraindications

1. Known allergy/hypersensitivity to mifepristone, misoprostol, or other prostaglandins
2. Confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass
3. IUD in place (must be removed first)
4. Chronic adrenal failure
5. Concurrent long-term corticosteroid therapy
6. Hemorrhagic disorder or concurrent anticoagulant therapy
7. Inherited porphyria
8. No access to emergency medical facilities (for managing incomplete abortion or hemorrhage)

Side Effects

• Common (intended): Uterine cramping, vaginal bleeding
• Less common: Nausea, vomiting, diarrhea, chills, fever
• Serious (rare, ~0.3%):
  • Excessive bleeding requiring blood transfusion
  • Infection (rare cases of Clostridium sordellii reported historically - now mitigated by buccal route and prophylactic doxycycline where indicated)

Follow-up

• Patient must return for follow-up ~14 days after mifepristone
• Confirm complete termination by clinical exam or ultrasound
• If ongoing pregnancy detected: risk of fetal malformation - surgical termination is strongly recommended

Special Notes

• Home administration of misoprostol is permitted (and widely practiced)
• Telemedicine prescribing is now allowed in many jurisdictions (including the US, post-FDA 2023 ruling)
• Misoprostol at 24, 48, or 72 hours after mifepristone gives equal efficacy
• The kit can be used by non-specialist providers (family physicians, midwives, nurse practitioners, physician assistants)

Recent Evidence