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Medication for Early Pregnancy Termination

To identify the key insights or developments described in this article
1 Credit CME

The US Food and Drug Administration (FDA) first approved a medication abortion regimen in 2000, which consisted of mifepristone (a progesterone antagonist that causes pregnancy tissue to detach from the endometrium) and misoprostol (a prostaglandin that induces cervical softening and uterine contractions). Current evidence-based regimens still rely on this drug combination, which is approved for abortions up to 10 weeks’ gestational age. In 2017 in the US, medication abortions accounted for an estimated 60% of abortions at less than 10 weeks’ gestation.1

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Stephanie B. Teal, MD, MPH, 11100 Euclid Ave, MAC 5034, Cleveland, OH 44106 (Stephanie.Teal@UHhospitals.org).

Published Online: June 2, 2022. doi:10.1001/jama.2022.6344

Conflict of Interest Disclosures: None reported.

References
1.
Jones  RK , Witwer  E , Jerman  J . Abortion Incidence and Service Availability in the United States, 2017. Guttmacher Institute; 2019.
2.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology, Society of Family Planning.  Medication abortion up to 70 days of gestation.   Obstet Gynecol. 2020;136(4):e31-e47.PubMedGoogle ScholarCrossref
3.
Questions and answers on Mifeprex. US Food and Drug Administration. Accessed May 23, 2022. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex
4.
Raymond  EG , Grossman  D , Mark  A ,  et al.  Commentary: no-test medication abortion.   Contraception. 2020;101(6):361-366.PubMedGoogle ScholarCrossref
5.
Ralph  LJ , Ehrenreich  K , Barar  R ,  et al.  Accuracy of self-assessment of gestational duration among people seeking abortion.   Am J Obstet Gynecol. 2022;226(5):e1-e21. doi:10.1016/j.ajog.2021.11.1373PubMedGoogle ScholarCrossref
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Tao  G , Patel  C , Hoover  KW .  Updated estimates of ectopic pregnancy among commercially and Medicaid-insured women in the United States, 2002-2013.   South Med J. 2017;110(1):18-24.PubMedGoogle ScholarCrossref
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Horvath  S , Tsao  P , Huang  Z-Y ,  et al.  The concentration of fetal red blood cells in first-trimester pregnant women undergoing uterine aspiration is below the calculated threshold for Rh sensitization.   Contraception. 2020;102(1):1-6.PubMedGoogle ScholarCrossref
8.
Schmidt-Hansen  M , Cameron  S , Lohr  PA , Hasler  E .  Follow-up strategies to confirm the success of medical abortion of pregnancies up to 10 weeks’ gestation: a systematic review with meta-analyses.   Am J Obstet Gynecol. 2020;222(6):551-563.e13.PubMedGoogle ScholarCrossref
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The Safety and Quality of Abortion Care in the United States. National Academies Press; 2018.
10.
Harris  LH , Grossman  D .  Complications of unsafe and self-managed abortion.   N Engl J Med. 2020;382(11):1029-1040.PubMedGoogle ScholarCrossref
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