Extending outpatient medical abortion in the late first trimester of pregnancy
Awarded 2020
Increasing access to medication abortion
Ilana Dzuba, MHS
Gynuity Health Projects

There is limited evidence supporting a highly effective medication regimen for outpatient medical abortion services at 11 and 12 weeks of gestation. Currently people seeking services at these gestational ages are generally limited to aspiration, and may need to travel farther to find a facility that provides this service. Having a reliable regimen for mifepristone-misoprostol medical abortion at 11-12 weeks would greatly expand access to safe abortion care, particularly at the 23% of clinics that only offer medical abortion and not aspiration. Extending the gestational age limit of first trimester medical abortion could also significantly impact the growing number of people choosing self-managed abortion, in particular reducing concerns over continuing pregnancies and how to handle them. We propose to conduct a prospective, open-label, multi-site study of the efficacy of medical abortion among people seeking pregnancy termination at 71-84 days of gestation. Our primary objective is to determine if an additional dose of 800 mcg buccal misoprostol to the standard mifepristone and single misoprostol dose regimen will yield an efficacy of at least 92%. Our secondary objectives concern patient experiences and patient and provider acceptability of medical abortion at 71-84 days of gestation. In addition to providing input on the final research protocol, site investigators and a multidisciplinary research advisory group will contribute to development of counseling information and materials tailored to the late first trimester, which will be piloted during the study and shared with the wider abortion community. We anticipate the research findings will lead to revisions in clinical practice guidelines, changes in practice by providers, and greater awareness by the general public on the safety and efficacy of medical abortion.