Version July 2025
This algorithm describes one approach to management of individuals undergoing second-trimester medication abortion. Individuals in this algorithm have already been determined to be candidates for second-trimester medication abortion (eg, by establishing the correct gestational age, identifying any medical factors [eg, bleeding diatheses, placenta previa] that may preclude medication abortion), and have been counseled about the risks, benefits, and alternatives (eg, dilation and evacuation). This information is discussed in related UpToDate content.
We do not change management for patients with a prior hysterotomy (eg, cesarean birth, myomectomy) as there is insufficient evidence to support a change in regimen in such patients.* In settings where mifepristone is not available or is too costly, misoprostol-only regimens are often used.
¶ Shorter (eg, simultaneous dosing, waiting 12 hours) and longer (eg, waiting 48 hours) intervals are also safe and effective.
Δ The dose, route, and dosing interval of misoprostol vary across protocols.
◊ A maximum number of misoprostol doses has not been established; however, most patients require fewer than 6 doses.
§ Most patients deliver within 48 hours.
¥ Practice varies and some experts discontinue misoprostol while waiting for the placenta to deliver.
‡ Patients with severe bleeding require prompt intervention; this is discussed in related UpToDate content.