A: Although one case- report revealed a failure of using mifepristone for medication abortion in a patient with a twin pregnancy, Hayes, J.L. et al., performed a secondary analysis of treatment efficacy and side effects on a population receiving mifepristone 200 mg orally and misoprostol 800 mcg vaginally for medication abortion up to 63 days and showed^[30]:

• Of 2208 subjects, 24 (1.1%) women had twins.
• Treatment success was not statistically different for twin and singleton gestations (91% vs 97%, p = 0.19).
• Perceived side effects, bleeding and pain were not statistically different between groups.

In the case report of one failure, Sorensen, E.C. et al., hypothesized that twin pregnancies may need higher dosage of mifepristone than single pregnancies^[31]. But no trial has been performed to test this hypothesis and this article was highly criticized by Hausknecht, R. in an author reply. Looking at these results, we think it is reasonable to perform a medication abortion with mifepristone & misoprostol in patients with a twin pregnancy up to 63 days.