SUMMARY POINTS

SKILL

  • Medication abortion (MAB) is technically simple. Skills for medication abortion include assessment of eligibility, counseling, evaluation of success, and evaluation and management of rare complications. 
  • Medication abortion is increasing globally. In 2017, nearly 40% of eligible patients chose medication abortion.  Medication abortion increases access, and one in 4 abortion providers in the U.S. offer only medication abortion (Jones 2019).
  • Combined mifepristone/misoprostol regimens are more effective than misoprostol alone or methotrexate/misoprostol (Kulier 2011, NAF 2020).
  • Mifepristone 200 mg followed by misoprostol 800 mcg (buccal or vaginal) or 400 to 800 mcg (sublingual) is an effective regimen (FDA label 2016).  Evidence-based protocols extend efficacy through 71-77 days LMP with a second dose of misoprostol 800mcg (Dzuba 2020; NAF 2020).
  • Regimens beyond 77 days are used in various global settings.

SAFETY

  • Medication abortion is safe and effective, with over 95% success rate without need for further intervention (Reeves 2016). Rarely, incomplete abortion or heavy bleeding may require outpatient treatment or aspiration up to several weeks after the abortion.
  • Mifepristone can safely be taken at home (NAF 2020; WHO 2018; Chong 2015), though U.S. regulation still requires it be dispensed in a clinical setting by a clinician.
  • The medication abortion occurs at home, similar to a miscarriage. You can:
    • Provide patients with a contact number for questions or concerns
    • Give your patients a list of “warning signs” that warrant a call or visit
    • Provide or refer for an aspiration procedure in the rare event that a patient needs this to complete an abortion.
  • Self-managed abortion (SMA) is the use of pills for abortion without the oversight by a licensed clinician. With appropriate instructions and timely access to care, evidence has demonstrated the safety and efficacy of SMA (WHO 2018; Aiken 2017; Murtagh 2017). Abortion care sites in the U.S. are increasingly reporting seeing one or more patients who had attempted SMA (18%) (Jones 2019). However, some states have laws against SMA and cases have been reported to the authorities.
  • Mifepristone is not effective for ectopic pregnancy. If mifepristone-miso or misoprostol alone-based regimen is given for pregnancy of unknown location (PUL), serial serum hCG evaluation is needed to rule out ectopic pregnancy. If early unruptured ectopic pregnancy is diagnosed, methotrexate regimens are indicated.

ROLE

  • Medication abortion is relatively easy to integrate into clinical practice, expands access to abortion care, and can be provided in settings without ultrasound or ability to provide uterine aspiration with appropriate referral option if needed.
  • Your confidence in providing medication abortion will grow quickly as you:
    • Gain experience monitoring side effects and assessing success
    • Listen to your patients’ questions and success stories
    • Discuss your questions with experienced colleagues.

License

EARLY ABORTION TRAINING CURRICULUM Copyright © 2020 by UCSF Bixby Center for Global Reproductive Health. All Rights Reserved.