Study: more research needed on medical abortion in the late first trimester

A new systematic review of medical abortion in the late first trimester reports a range of efficacy and provides reassurance that adverse events are rare, but highlights the need for further research.

A growing proportion of induced abortions in the United States and internationally are medical abortions. There are few medical requirements for safe provision of medical abortion drugs, and the abortion process in early pregnancy can generally be managed by the woman.

Current evidence supports the home use of mifepristone and misoprostol up to 70 days gestation, and emphasizes the need for routine, repeated misoprostol dosing beyond 70 days. But the systematic review, published in the journal Contraception, says more research is needed to strengthen that body of evidence.

Dr. Nathalie Kapp, Ipas Associate Medical Director and lead author of the review, says that expanding the gestational ages at which medical abortion can be safely offered is a promising way to increase women’s access to high-quality abortion services. Further research could also help to determine whether the gestational age for home use of medical abortion is appropriate beyond 70 days, she says.

The review sought out studies that had examined the success of medical abortion at gestational ages in the range of greater than 63 days and less than 84 days. More than 3,000 articles were considered, but only nine met the review criteria. The articles considered issues such as frequency of dosing, medical abortion versus surgical abortion in this gestational age range, and whether the medical abortion was carried out in a health facility or through outpatient management.

Read an early version of the review published in the journal Contraception.

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