The objective of this Clinical Recommendation is to review relevant literature and provide evidence-based recommendations for medication abortion between 14 0/7 and 27 6/7 weeks of gestation, with a focus on mifepristone-misoprostol and misoprostol-only regimens. We systematically reviewed PubMed articles published between 2008 and 2022 and reviewed reference lists of included articles to identify additional ... Read more >

Hemorrhage after abortion is rare, occurring in fewer than 1% of abortions, but associated morbidity may be significant. Although medication abortion is associated with more bleeding than procedural abortion, overall bleeding for the two methods is minimal and not clinically different. Hemorrhage can be caused by atony, coagulopathy, and abnormal placentation, as well as by ... Read more >

Standardization of abortion nomenclature and terms used to refer to different types of abortion will increase uniformity and accuracy in communication about abortion care. The Society of Family Planning’s recommendation is to use the terms medication abortion and procedural abortion for common use in clinical guidance, journal articles, print materials, websites, media, advocacy, policy briefs, ... Read more >

Mifepristone approval by the United States (U.S.) Food and Drug Administration in 2000 revolutionized abortion care in this country. In the aftermath of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization which eliminated federal constitutional protections for abortion, the accessibility and availability of mifepristone are under increasing threat. Medication abortion regimens ... Read more >

On January 3, 2023, updates to the U.S. Food and Drug Administration (FDA) risk evaluation and mitigation strategy (REMS) for mifepristone for reproductive health indications went into effect. The FDA has permanently removed the in-person dispensing requirement and added a new pharmacy certification process, which will enable retail pharmacies that meet certain qualifications to dispense ... Read more >

As access to legal abortion in the formal healthcare system becomes more restricted across the United States (U.S.), there has been increased focus on understanding the ways that individuals may seek care outside of the healthcare system, including through self-managed abortion (SMA). SMA refers to any action taken to end a pregnancy outside of the ... Read more >

The highly politicized nature of abortion care in this country can make it difficult for institutions and obstetric providers to thoughtfully remark upon and plan for policy decisions that impact patient care. Individuals at high risk for pregnancy mortality and morbidity have unique needs for reproductive health services, including abortion care. Variations in state and ... Read more >

Historical evidence that fetal red blood cell (RBC) exposure during early spontaneous or induced abortion can cause maternal Rh sensitization is limited. A close reading of these studies indicates that forgoing Rh immunoglobulin administration before 12weeks gestation is highly unlikely to increase risk of Rh (D) antibody development, and recent studies indicate that fetal RBC ... Read more >

Cesarean scar ectopic pregnancy is a complication in which an early pregnancy implants in the scar from a previous cesarean delivery. This condition presents a substantial risk for severe maternal morbidity and mortality because of challenges in securing a prompt diagnosis. Ultrasound is the primary imaging modality for cesarean scar ectopic pregnancy diagnosis, although a ... Read more >

Pain is a complex phenomenon that involves more than a simple physical response to external stimuli. In maternal-fetal surgical procedures, fetal analgesia is used primarily to blunt fetal autonomic responses and minimize fetal movement. The purpose of this Consult is to review the literature on what is known about the potential for fetal awareness of ... Read more >