Medical Abortion

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Basics

Description

  • Medical abortion is induced termination of an early pregnancy by use of medications.
  • The U.S. FDA has approved a combination of two medications, mifepristone (RU-486) an antiprogesterone and misoprostol a prostaglandin for pregnancies of up to 70 days gestation. The medications are given in succession to interfere with development of the embryo and to expel the products of conception (POC), respectively.
  • Methotrexate was used in medical protocols before mifepristone and remains a useful medication when ectopic pregnancy is possible. Misoprostol (prostaglandin analogue) alone is used in some areas for termination (less effective than combination with mifepristone) as well as for management of incomplete/missed abortion.
  • Women may prefer medical abortion if they desire to avoid surgery, considering it to be a more natural and private process compared with surgical abortion. WHO notes that the technique is well suited to provision in primary care in both high- and low-resource settings (1).

Epidemiology

Incidence
  • There are approximately 62 million women of reproductive age and 6.4 million pregnancies per year in the United States. Of these, about 48% are unintended.
  • 40% of unintended pregnancies end in termination.
  • The overall rate of abortion is declining and was around 12.1 abortions per 1,000 women of reproductive age in 2014, with 186 abortions per 1,000 live births. Induced abortions in the United States total about 1.2 million yearly.
  • There were about 652,000 abortions reported to CDC in 2014, of which about 23% were medical abortions. The proportion of abortions by medical means is increasing.
  • States have varying regulatory requirements regarding preprocedure ultrasound, mandatory waiting periods between patient counseling and the abortion, and the need for parental involvement when minors seek abortion.

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Basics

Description

  • Medical abortion is induced termination of an early pregnancy by use of medications.
  • The U.S. FDA has approved a combination of two medications, mifepristone (RU-486) an antiprogesterone and misoprostol a prostaglandin for pregnancies of up to 70 days gestation. The medications are given in succession to interfere with development of the embryo and to expel the products of conception (POC), respectively.
  • Methotrexate was used in medical protocols before mifepristone and remains a useful medication when ectopic pregnancy is possible. Misoprostol (prostaglandin analogue) alone is used in some areas for termination (less effective than combination with mifepristone) as well as for management of incomplete/missed abortion.
  • Women may prefer medical abortion if they desire to avoid surgery, considering it to be a more natural and private process compared with surgical abortion. WHO notes that the technique is well suited to provision in primary care in both high- and low-resource settings (1).

Epidemiology

Incidence
  • There are approximately 62 million women of reproductive age and 6.4 million pregnancies per year in the United States. Of these, about 48% are unintended.
  • 40% of unintended pregnancies end in termination.
  • The overall rate of abortion is declining and was around 12.1 abortions per 1,000 women of reproductive age in 2014, with 186 abortions per 1,000 live births. Induced abortions in the United States total about 1.2 million yearly.
  • There were about 652,000 abortions reported to CDC in 2014, of which about 23% were medical abortions. The proportion of abortions by medical means is increasing.
  • States have varying regulatory requirements regarding preprocedure ultrasound, mandatory waiting periods between patient counseling and the abortion, and the need for parental involvement when minors seek abortion.

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