Patient-Oriented Evidence That Matters

Misoprostol Alone Is Associated with a High Rate of Successful First-Trimester Abortion


Am Fam Physician. 2019 Jul 15;100(2):119.

Clinical Question

Is misoprostol (Cytotec) alone associated with a high rate of success when used for first-trimester abortion of a viable pregnancy?

Bottom Line

Misoprostol alone was associated with a nearly 80% success rate in the first trimester of pregnancy on meta-analysis. The best associations were with 800-mg dosing, three or more doses, non-oral route of administration, moistening of tablets before vaginal insertion, and a delay of three to seven days after completion of the misoprostol regimen before the decision to surgically evacuate. The safety of misoprostol alone was demonstrated by a rate of hospitalization and/or transfusion of less than 1%. (Level of Evidence = 2a)


This is an updated meta-analysis of misoprostol alone for abortion in the first trimester of pregnancy. Selected studies included women with viable pregnancies of variable gestational age limit, ranging from 42 to 98 days, nearly universally determined by ultrasonography. The meta-analysis included 42 studies with 53 study groups and 13,573 women. A total of 12,829 women were included in the analysis after the exclusion of 744 who were lost before outcomes were known (5%). There were multiple regimens, with dosing from 200 mg to 800 mg. The most common dose was 800 mg (n = 40 groups, 92% of women); the most common route of administration was vaginal (n = 38 groups, 81% of women). Most women were instructed to take no more than three doses within 48 hours. After one or more required doses, women in 35 groups (38% of women) could use additional doses, up to a maximum of six doses over 14 days. Across all studies, the meta-analytic estimate of the rate of women who underwent subsequent surgical evacuation was 22.0% (95% CI, 18.8% to 25.5%). The authors analyzed heterogeneity across studies and identified several factors associated with higher risk of surgical evacuation. They demonstrated a linear trend (P < .001) with the 800-mg dosing being approximately one-fourth the risk of the 200-mg

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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