A medical abortion is a type of non-surgical abortion

Abortion

Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...

 in which abortifacient

Abortifacient

An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....

 pharmaceutical drugs are used to induce abortion. An oral preparation for medical abortion is commonly referred to as an abortion pill.

Medical abortion became an alternative method of abortion with the availability of prostaglandin

Prostaglandin

A prostaglandin is any member of a group of lipid compounds that are derived enzymatically from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring....

 analog

Prostaglandin analogue

Synthetic prostaglandin analogues are molecules which are manufactured to bind to a prostaglandin receptor.Wider use of prostaglandin analogues is limited by unwanted side effects and their abortive potential.-Uses:...

s in the early 1970s and the antiprogestogen mifepristone

Mifepristone

Mifepristone is a synthetic steroid compound used as a pharmaceutical. It is a progesterone receptor antagonist used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive. During early trials, it was known as RU-38486 or simply RU-486, its...

 in the 1980s.

Regimens

The most common early first-trimester medical abortion regimens use mifepristone in combination with a prostaglandin analog (misoprostol

Misoprostol

Misoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug induced gastric ulcers, for early abortion, to treat missed miscarriage, and to induce labor. The latter use is controversial in the United States. Misoprostol was invented and marketed by G.D...

 or gemeprost

Gemeprost

Gemeprost is an analogue of prostaglandin E1.-Clinical use:It is used as a treatment for obstetric bleeding.It is used with RU486 to terminate pregnancy up to 24 weeks gestation...

) up to 63 days of gestational age

Gestational age

Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....

, methotrexate

Methotrexate

Methotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...

 in combination with a prostaglandin analog up to 49 days gestation, or a prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens. Mifepristone–misoprostol and methotrexate–misoprostol combination regimens are more effective than misoprostol alone.

Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used to induce second-trimester abortions in Canada

Canada

Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

, most of Europe

Europe

Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...

, China

China

Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

 and India

India

India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

; in contrast to the United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 where 96% of second-trimester abortions are performed surgically by dilation and evacuation

Dilation and evacuation

Dilation and evacuation literally refers to the dilation of the cervix and surgical evacuation of the contents of the uterus...

.

The early first-trimester medical abortion regimen (200 mg of oral mifepristone, followed 24–48 hours later by 800 mcg of buccal misoprostol) currently used by Planned Parenthood

Planned Parenthood

Planned Parenthood Federation of America , commonly shortened to Planned Parenthood, is the U.S. affiliate of the International Planned Parenthood Federation and one of its larger members. PPFA is a non-profit organization providing reproductive health and maternal and child health services. The...

 clinics in the United States since April 2006 is 98.3% effective through 59 days gestation.The medical abortion regimen (200 mg of oral mifepristone, followed 24–48 hours later by 800 mcg of vaginal misoprostol) previously used by Planned Parenthood clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of patients having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or patient request.

A 2011 systematic review found that it was simpler and equally safe to administer mifepristone in clinic and have the pregnant woman later take misoprostol at home as it was to administer both drugs in the clinic.

Cost

In the United States in 2009, the median price charged for a medical abortion up to 9 weeks gestation was $490, four percent higher than the $470 median price charged for a surgical abortion at 10 weeks gestation. In the United States in 2008, 57% of women who had abortions paid for them out of pocket.

Prevalence

Medical abortions as a percentage of all abortions

Country	Percentage
Spain Spain Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...	4% in 2009
Netherlands Netherlands The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...	12% in 2008
Belgium Belgium Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...	17% in 2009
Germany Germany Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...	17% in 2010
United States United States The United States of America is a federal constitutional republic comprising fifty states and a federal district...	17% in 2008
Denmark Denmark Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...	38% in 2006
England and Wales England and Wales England and Wales is a jurisdiction within the United Kingdom. It consists of England and Wales, two of the four countries of the United Kingdom...	43% in 2010
France France The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...	52% in 2009
Iceland Iceland Iceland , described as the Republic of Iceland, is a Nordic and European island country in the North Atlantic Ocean, on the Mid-Atlantic Ridge. Iceland also refers to the main island of the country, which contains almost all the population and almost all the land area. The country has a population...	57% in 2009
Switzerland Switzerland Switzerland name of one of the Swiss cantons. ; ; ; or ), in its full name the Swiss Confederation , is a federal republic consisting of 26 cantons, with Bern as the seat of the federal authorities. The country is situated in Western Europe,Or Central Europe depending on the definition....	62% in 2010
Sweden Sweden Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....	71% in 2010
Scotland Scotland Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...	72% in 2010
Norway Norway Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...	73% in 2010
Finland Finland Finland , officially the Republic of Finland, is a Nordic country situated in the Fennoscandian region of Northern Europe. It is bordered by Sweden in the west, Norway in the north and Russia in the east, while Estonia lies to its south across the Gulf of Finland.Around 5.4 million people reside...	86% in 2010

A Guttmacher Institute

Guttmacher Institute

The Guttmacher Institute is a non-profit organization which works to advance sexual and reproductive health. The institute operates in the United States and globally "through an interrelated program of social science research, policy analysis and public education." According to their mission...

 survey of abortion providers estimated that early medical abortions accounted for 17% of all nonhospital abortions and slightly over one-quarter of abortions before 9 weeks gestation in the United States in 2008; medical abortions accounted for 32% of first trimester abortions at Planned Parenthood clinics in the United States in 2008.

Health risks

Reviews in 2004 and 2006 for the WHO

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 Reproductive Health Library found that:

Medical methods for first trimester abortion have been demonstrated to be both safe and effective. Regimens that combine mifepristone or methotrexate with a prostaglandin such as misoprostol are more efficacious than a prostaglandin alone.

Prostaglandins alone seem to be less effective and more painful than surgical abortion. Evidence is inadequate on the acceptability and side-effects of the two methods. The medical approach avoids the use of anesthetics; this and the possibility of using it as an outpatient procedure may offer an advantage in under-resourced settings.

According to the 2006 WHO Frequently asked clinical questions about medical abortion, regarding factors that should be taken into account when counseling a woman about her choice between medical and surgical abortion:

There is little, if any, difference between medical and surgical abortion in terms of safety and efficacy. Thus, both methods are similar from a medical point of view and there are only very few situations where a recommendation for one or the other method for medical reasons can be given.

Medical abortion may be preferred:

• if it is the woman’s preference;
• in very early gestation; up to 49 days of gestation, medical abortion is considered to be more effective than surgical abortion, especially when clinical practice does not include detailed inspection of aspirated tissue;
• if the woman is severely obese (body mass index
  Body mass index
  The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...
  
   greater than 30) but does not have other cardiovascular risk factors, as surgical treatment may be technically more difficult;
• if the woman has uterine malformation
  Uterine malformation
  A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct during embryogenesis...
  
  s or a fibroid uterus
  Uterine fibroids
  A uterine fibroid is a benign tumor that originates from the smooth muscle layer and the accompanying connective tissue of the uterus.Fibroids are the most common benign tumors in...
  
  , or has previously had cervical surgery (which may make surgical abortion technically more difficult);
• if the woman wants to avoid a surgical intervention.

Surgical abortion may be preferred:

• if it is the woman’s preference, or if she requests concurrent sterilization;
• if she has contraindications to medical abortion;
• if time or geographical constraints preclude the follow-up needed to confirm that abortion is complete.

Since 2001, ten women—one in Canada, eight in the United States, one in Portugal—have died from clostridial

Clostridium

Clostridium is a genus of Gram-positive bacteria, belonging to the Firmicutes. They are obligate anaerobes capable of producing endospores. Individual cells are rod-shaped, which gives them their name, from the Greek kloster or spindle...

 toxic shock syndrome

Toxic shock syndrome

Toxic shock syndrome is a potentially fatal illness caused by a bacterial toxin. Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative bacteria include Staphylococcus aureus and Streptococcus pyogenes...

 (nine from Clostridium sordellii

Clostridium sordellii

Clostridium sordellii is a rare anaerobic, gram-positive, spore forming rod with peritrichous flagella that is capable of causing pneumonia, endocarditis, arthritis, peritonitis, and myonecrosis. C. sordellii bacteremia and sepsis occur rarely. Most cases of sepsis from C. sordellii occur in...

, one from Clostridium perfringens

Clostridium perfringens

Clostridium perfringens is a Gram-positive, rod-shaped, anaerobic, spore-forming bacterium of the genus Clostridium. C. perfringens is ever present in nature and can be found as a normal component of decaying vegetation, marine sediment, the intestinal tract of humans and other vertebrates,...

) following early medical abortions using 200 mg mifepristone orally followed by 800 mcg misoprostol—nine vaginally, one buccally

Buccal

Buccal may refer to:* Mouth, a body cavity** Specifically the cheek* Buccal artery...

—without prophylactic antibiotics.

A retrospective study

Retrospective cohort study

A retrospective cohort study, also called a historic cohort study, generally means to take a look back at events that already have taken place...

 published in The New England Journal of Medicine in July 2009 of 227,823 women who underwent medical abortion at Planned Parenthood affiliate centers from January 2005 through June 2008, found that the rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal

Buccal

Buccal may refer to:* Mouth, a body cavity** Specifically the cheek* Buccal artery...

 administration of misoprostol combined with the routine prophylactic administration of doxycycline

Doxycycline

Doxycycline INN is a member of the tetracycline antibiotics group, and is commonly used to treat a variety of infections. Doxycycline is a semisynthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin...

 antibiotics.

A table in the 2010 Handbook of Obstetric and Gynecologic Emergencies, 4th edition lists these possible complications of medical and surgical abortion:

• Medical abortion
  • Hemorrhage
  • Incomplete abortion
  • Uterine or pelvic infection
  • Ongoing intrauteine pregnancy, requiring a surgical abortion for completion
  • Misdiagnosed/unrecognized ectopic pregnancy
    Ectopic pregnancy
    An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
    
    
• Surgical abortion
  • Hemorrhage
  • Incomplete abortion
  • Uterine or pelvic infection
  • Ongoing intrauteine pregnancy, requiring a second procedure
  • Misdiagnosed/unrecognized ectopic pregnancy
  • Hematometra
    Hematometra
    Hematometra is a medical condition involving collection of blood in the uterus. It can rarely be caused by a proximal transverse vaginal septum, as can hematosalpinx.A collection or retention of blood in the uterine cavity. Also called hemometra....
    
     (blood clots accumulating in the uterus)
  • Uterine perforation
  • Cervical laceration

Contraindications

According to the 2006 WHO Frequently asked clinical questions about medical abortion:

There are very few absolute contraindications to medical abortion. They include:

• previous allergic reaction to one of the drugs involved;
• inherited porphyria
  Porphyria
  Porphyrias are a group of inherited or acquired disorders of certain enzymes in the heme bio-synthetic pathway . They are broadly classified as acute porphyrias and cutaneous porphyrias, based on the site of the overproduction and accumulation of the porphyrins...
  
  ;
• chronic adrenal failure
  Adrenal insufficiency
  Adrenal insufficiency is a condition in which the adrenal glands, located above the kidneys, do not produce adequate amounts of steroid hormones , primarily cortisol, but may also include impaired aldosterone production which regulates sodium, potassium and water retention...
  
  ;
• known or suspected ectopic pregnancy.

Caution is required in a range of circumstances including:

• if the woman is on long-term corticosteroid
  Corticosteroid
  Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
  
  therapy (including those with severe, uncontrolled asthma);
• if she has a hemorrhagic disorder;
• if she has severe anemia;
• if she has pre-existing heart disease or cardiovascular risk factors (e.g. hypertension and smoking).

External links

• The ICMA Information Package on Medical Abortion The International Consortium for Medical Abortion (ICMA)