• Mifepristone + Misoprostol (the "Safe-T Kit" shown) is a prescription-only medication in India, legally required to be used only under medical supervision (as stated on the packaging itself).
• At 8 weeks of pregnancy, the correct dosing protocol, timing, and follow-up must be determined by a qualified provider who can assess the individual's health, confirm gestational age by ultrasound, rule out contraindications (ectopic pregnancy, bleeding disorders, IUD in place, etc.), and manage complications.
• Incorrect use can cause serious or life-threatening complications including severe hemorrhage, incomplete abortion, or infection.

1. Visit a registered gynecologist or doctor - this is the safest and most effective path.
2. Government options in India (free/low-cost):
   • Any government hospital OPD/gynecology ward
   • Jan Aushadhi clinics
3. Helpline: Call 1800-103-4488 (National Family Planning helpline, India) for guidance on nearby services.
4. Planned Parenthood equivalent in India: Look for clinics registered under the MTP Act (Medical Termination of Pregnancy Act).

• These are Schedule H prescription drugs in India - illegal to dispense or use without a doctor's prescription and supervision.
• At 8 weeks, an ultrasound is required first to confirm the pregnancy is not ectopic (in the fallopian tube). Taking these tablets with an undiagnosed ectopic pregnancy can be fatal.
• Complications like heavy bleeding, incomplete abortion, and infection require immediate medical intervention - you need a provider who knows you took the medication.

• 1800-103-4488 - Free, confidential, 24/7 family planning helpline (India)
• They can direct you to the nearest registered provider who can supervise this safely today.

• Any government hospital gynecology OPD - show them this kit. They will guide you through the protocol under proper supervision, often at no cost.

Medical Abortion Protocol - Mifepristone + Misoprostol (Up to 9 weeks / 63 days)

Patient Criteria (Before Prescribing)

• Confirmed intrauterine pregnancy (ultrasound mandatory)
• Gestational age ≤ 63 days (9 weeks) for this regimen
• No contraindications (see below)
• Hemoglobin ≥ 8 g/dL
• No IUD in situ (must be removed first)

Standard Regimen

• The Safe-T Kit contains exactly this: 1 tablet Mifepristone 200mg + 4 tablets Misoprostol 200mcg each (= 800mcg total)

Misoprostol Administration Detail

• Sublingual: Place 4 tablets (200mcg each) under the tongue, keep for 30 minutes, then swallow remnants
• Buccal: Place 2 tablets in each cheek pouch, keep for 30 minutes, swallow remnants
• Both routes are equally effective at this gestational age

Expected Side Effects to Counsel Patient On

• Cramping and bleeding within 1-4 hours of misoprostol (normal)
• Passage of products of conception within 4-8 hours
• Nausea, vomiting, diarrhea, low-grade fever (prostaglandin effect)
• Bleeding may continue 1-3 weeks (spotting)

Red Flags - Return Immediately If:

• Soaking more than 2 pads/hour for 2+ consecutive hours
• Fever > 38°C persisting beyond 24 hours after misoprostol
• Severe abdominal pain not relieved by NSAIDs
• No bleeding within 24 hours of misoprostol

Contraindications

• Suspected ectopic pregnancy
• Coagulopathy or anticoagulant therapy
• Chronic adrenal failure
• Corticosteroid therapy (long-term)
• Allergy to mifepristone or prostaglandins
• IUD in situ (remove before use)
• Inherited porphyria

Follow-Up

• 2 weeks post-procedure: Confirm complete abortion via ultrasound or serum beta-hCG
• Efficacy at ≤ 8 weeks: 95-98% complete abortion rate
• If incomplete: repeat misoprostol or surgical evacuation (MVA/D&C)

Rh Factor

• If patient is Rh-negative: administer Anti-D immunoglobulin 300 mcg within 72 hours

Safe-T Kit - Step by Step

Step 1 - Day 1

• Mifepristone 200mg × 1 tablet
• Route: Oral (swallow with water)
• Time: Note the exact time taken

Step 2 - Day 2 or Day 3 (24 to 48 hours later)

• Misoprostol 200mcg × 4 tablets (= 800mcg total)
• Route: Sublingual (under the tongue)
• Hold all 4 tablets under the tongue for 30 minutes
• After 30 minutes, swallow the remaining dissolved remnants with water
• Optimal window: 24-48 hours after Mifepristone - both are equally effective
• Most clinicians prefer 48 hours for slightly better efficacy

Timing Note

What to Expect After Misoprostol

• Cramping starts within 1-2 hours
• Bleeding and passage of POC within 2-6 hours
• Give Ibuprofen 400-800mg 30 minutes before misoprostol for pain management
• Antiemetic (Ondansetron 4mg) can be given 30 min prior to reduce nausea

Follow Up

• Confirm complete expulsion at 2 weeks via ultrasound
• If incomplete - repeat Misoprostol 800mcg or proceed to surgical evacuation