Medication Abortion Failure in a Patient With Class III Obesity and Twin Gestation: A Case Report

There is a paucity of clinical data stratifying medication abortion (MAB) success rates by obesity class or multifetal gestation. With rising rates of class III obesity, it is important to assess the efficacy of current MAB protocols in this population. A 30-year-old G3P1011 at six weeks two days (6w2d) with a diamniotic, dichorionic twin gestation and a body mass index (BMI) of 53, elected for MAB. She received 200 mg oral mifepristone followed by two doses of 800 mcg buccal misoprostol over 48 hours. Minimal symptoms occurred initially, and she ultimately required manual vacuum aspiration 31 days later for retained products. This case highlights possible limitations of standard MAB regimens in class III obesity with twin gestation, suggesting altered pharmacokinetics and the need for further research to optimize care.