Medication abortion with misoprostol-only: A sample protocol

Raymond, Elizabeth G.; Mark, Alice; Grossman, Daniel; Beasley, A. W.; Brandi, Kristyn; Castle, Jen; Creinin, Mitchell D.; Gerdts, Caitlin; Gil, Laura Zumaquero; Grant, Melissa; Lockley, April; Perritt, Jamila; Shochet, Tara; Truan, Dominique; Upadhyay, Ushma D.

doi:10.1016/j.contraception.2023.109998

Cited by 14 publications

(8 citation statements)

References 45 publications

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“…Medication abortion with mifepristone and misoprostol and misoprostol-only regimens both have high success rates and the majority using medication abortion have successful outcomes independent of in-person follow-up care (Box 1) [38–42]. Yet, faced with possible medication failure with resultant ongoing pregnancy and need for additional travel, patients may want follow-up care for reassurance [43 ▪ ].…”

Section: Considerations For Clinical Practicementioning

confidence: 99%

Travel for abortion care: implications for clinical practice

Lerma,

Coplon,

Goyal

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Traveling long distances to obtain abortion care due to restrictions and scarce availability is associated with significant obstacles. We review clinical strategies that can facilitate abortion access and outline considerations to ensure person-centered and equitable care. Recent findings Establishing a patient's gestational duration prior to travel may be beneficial to ensure they are eligible for their desired abortion method at the preferred facility or to determine if a multiday procedure is required. If a local ultrasound cannot be obtained prior to travel, evidence demonstrates people can generally estimate their gestational duration accurately. If unable to provide care, clinicians should make timely referrals for abortion. Integration of telemedicine into abortion care is safe and well regarded by patients and should be implemented into service delivery where possible to reduce obstacles to care. Routine in-person follow-up care is not necessary. However, for those who want reassurance, formalized pathways to care should be established to ensure people have access to care in their community. To further minimize travel-related burdens, facilities should routinely offer information about funding and practical support, emotional support, and legal resources. Summary There are many opportunities to optimize clinical practice to support those traveling for abortion care.

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Section: Considerations For Clinical Practicementioning

confidence: 99%

Travel for abortion care: implications for clinical practice

Lerma,

Coplon,

Goyal

2023

Current Opinion in Obstetrics &Amp; Gynecology

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“…6 Although not FDA-approved, as a solo regimen for medication abortion, misoprostol is FDAapproved as part of the mifepristone regimen for medication abortion up to 10 weeks gestation. 7 Misoprostol is widely studied, and frequently used, off-label, for a variety of obstetrical and gynecologic clinical situations, including labor induction, 8 cervical ripening before surgical termination of pregnancy in the second trimester, 9,10 obstetrical hemorrhage, 11 postabortion hemorrhage 12 misoprostolonly medication abortion regimens, 13 and cervical softening in the setting of cervical stenosis when intrauterine access is needed (endometrial sampling, hysteroscopic procedures, etc). 14 The current FDA-approved regimen for medication abortion includes 200 mg of oral mifepristone, followed by 800 mcg of buccal misoprostol 24 to 48 hours later up to 10 weeks gestation.…”

Section: Regimensmentioning

confidence: 99%

Medication Abortion: A Comprehensive Review

Fleurant,

McCloskey

2023

Clinical Obstetrics &Amp; Gynecology

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This chapter provides an overview of evidence-based guidelines for medication abortion in the first trimester. We discuss regimens, both FDA-approved and other clinical-based protocols, and will briefly discuss novel self-managed abortion techniques taking place outside the formal health care system. Overview of patient counseling and pain management are presented with care to include guidance on “no touch” regimens that have proven both feasible and effective. We hope that this comprehensive review helps the health care community make strides to increase access to abortion in a time when reproductive health care is continuously restricted.

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“…The aim of much of the clinical literature on misoprostol alone was to establish recommended dosing and administration routes; as a result, clinical data on the effectiveness of currently endorsed misoprostol-alone protocols are sparse . There are only 2 clinical trials on misoprostol-alone regimens that use the currently endorsed regimen: 800-μg misoprostol tablets administered sublingually, vaginally, or buccally every 3 hours for at least 3 doses (2400 μg total) . In a 2007 study, 84% of 1025 participants with pregnancy duration less than 9 weeks randomized to an arm following this regimen had a complete abortion without procedural intervention at 2-week follow-up .…”

Section: Introductionmentioning

confidence: 99%

Medication Abortion Safety and Effectiveness With Misoprostol Alone

Jayaweera,

Egwuatu,

Nmezi

et al. 2023

JAMA Netw Open

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ImportanceMisoprostol-alone regimens for abortion may be more effective than previously thought.ObjectiveTo estimate the effectiveness of medication abortion with misoprostol alone among individuals self-managing their abortion.Design, Setting, and ParticipantsFor this prospective observational cohort study of callers to safe abortion hotlines and accompaniment groups in Argentina, Nigeria, and Southeast Asia, participants were recruited between July 31, 2019, and October 1, 2020, prior to starting their medication abortion. Eligible participants were 13 years or older, had no contraindications to medication abortion, and were not currently bleeding. Participants completed a baseline and 2 follow-up surveys. The analysis was restricted to participants who reported using misoprostol alone and was performed between January 6, 2022 and September 8, 2023.ExposureSelf-managed medication abortion using misoprostol alone.Main Outcomes and MeasuresThe primary outcome was effectiveness, defined as participant self-report of complete abortion without procedural intervention, measured at 1 week and 3 weeks after taking misoprostol. Secondary outcomes included method safety, measured by self-report of experiencing warning signs (eg, heavy bleeding, pain, fever, discharge) indicative of a potential complication and by medical treatment (eg, blood transfusion, intravenous fluids, overnight hospital stay) indicative of a potential adverse event. Additional outcomes included length of bleeding and cramping, time to expulsion, and experience of adverse effects.ResultsAmong 1352 enrolled participants, 637 used misoprostol-alone regimens for abortion and were included in the analysis (591 [92.8%] from Nigeria, 45 [7.1%] from Southeast Asia, and 1 [0.2%] from Argentina; 384 [60.2%] aged 20-29 years; 317 [49.8%] with pregnancy durations &lt;7 weeks and 205 [32.2%] with pregnancy durations between 7 and &lt;9 weeks). At last follow-up after taking medication (median, 22 days; IQR, 21-26 days), 625 participants (98.1%; 95% CI, 96.7%-98.9%) had a complete abortion without procedural intervention. Potential adverse events were reported by 6 participants (0.9%; 95% CI, 0.4%-2.1%). Most participants experienced bleeding for less than 1 week (median, 4 days; IQR, 3-6 days) and expelled their pregnancy within 24 hours of starting the abortion process (median, 12 hours; IQR, 9-15 hours). Common side effects included nausea (335 participants [52.6%]), fever (232 [36.4%]), and diarrhea (181 [28.4%]).Conclusions and RelevanceThe findings suggest that misoprostol alone is a highly effective method of pregnancy termination. Future research should explore strategies to maximize the effectiveness of misoprostol alone in clinical and nonclinical settings.

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Medication abortion with misoprostol-only: A sample protocol

Cited by 14 publications

References 45 publications

Travel for abortion care: implications for clinical practice

Travel for abortion care: implications for clinical practice

Medication Abortion: A Comprehensive Review

Medication Abortion Safety and Effectiveness With Misoprostol Alone

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