Second Trimester Medication Abortion Regimens and the Mifepristone-Misoprostol Dosing Interval

Purpose of ReviewThe purpose of this article is to review current methods of induction termination of pregnancy in the second trimester. The specific area of focus is recent publication regarding timing of mifepristone and misoprostol dosing. Current international guidelines recommend initial treatment with mifepristone followed by misoprostol after 24 to 48 h.Recent FindingsRetrospective studies indicate that a shorter interval between mifepristone and misoprostol of less than 12 h or even concomitant administration may result in a shorter total abortion time without increasing risk of incomplete abortion or complications.Given the potential benefit of increased efficacy, with successful expulsion of the pregnancy, and reduced time to delivery with shorter mifepristone-misoprostol intervals or concurrent administration practitioners should offer all second trimester medication abortion treatment with mifepristone. Further studies are needed to evaluate the implementation of concurrent or varied dosing intervals and the magnitude of benefit vs risks, with attention to the patient experience, resources, and costs.