We conducted a systematic review of the literature on the effectiveness of medical abortion “reversal” treatment. Since the usual care for women seeking to continue pregnancies after ingesting mifepristone is expectant management with fetal surveillance, we also performed a systematic review of continuing pregnancy after mifepristone alone.
We searched PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus and the Cochrane Library for articles published through March 2015 reporting the proportion of pregnancies continuing after treatment with either mifepristone alone or after an additional treatment following mifepristone aimed at reversing its effect.
From 1115 articles retrieved, 1 study met inclusion criteria for abortion reversal, and 13 studies met criteria for continuing pregnancy after mifepristone alone. The one report of abortion reversal was a case series of 7 patients receiving varying doses of progesterone in oil intramuscularly or micronized progesterone orally or vaginally; 1 patient was lost to follow-up. The study was of poor quality and lacked clear information on patient selection. Four of six women continued the pregnancy to term [67%, 95% confidence interval (CI) 30–90%]. Assuming the lost patient aborted resulted in a continuing pregnancy proportion of 57% (95% CI 25–84%). The proportion of pregnancies continuing 1–2 weeks after mifepristone alone varied from 8% (95% CI 3–22%) to 46% (95% CI 37–56%). Continuing pregnancy was more common with lower mifepristone doses and advanced gestational age.
In the rare case that a woman changes her mind after starting medical abortion, evidence is insufficient to determine whether treatment with progesterone after mifepristone results in a higher proportion of continuing pregnancies compared to expectant management.
Legislation requiring physicians to inform patients about abortion reversal transforms an unproven therapy into law and represents legislative interference in the patient–physician relationship.
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- Practice Bulletin No 143: Medical management of first-trimester abortion.Obstet Gynecol. 2014; 123: 676-692
- Safe abortion: technical and policy guidance for health systems.2nd ed. WHO, Geneva2012
- Women's perceptions on medical abortion.Contraception. 2006; 74: 11-15
- Abortion incidence and service availability in the United States, 2011.Perspect Sex Reprod Health. 2014; 46: 3-14
- Arizona Senate Bill 1318.(Available at)[Accessed 25 April 2015])
- Medication Abortion Reversal.(Available at)http://www.acog.org/-/media/Departments/State-Legislative-Activities/2015AZFactSheetMedicationAbortionReversalfinal.pdf?dmc=1&ts=20150425T1907218559([Accessed 25 April 2015])
- Progesterone use to reverse the effects of mifepristone.Ann Pharmacother. 2012; 46: e36
- Therapeutic abortion in early pregnancy with antiprogestogen RU486 alone or in combination with prostaglandin analogue (gemeprost).Contraception. 1986; 34: 459-468
- The antiprogestational agent RU 486 as an abortifacient in early human pregnancy: a comparison of three dose regimens.Contraception. 1988; 38: 391-400
- Early abortion with a single dose of the antiprogestin RU-486.Am J Obstet Gynecol. 1988; 158: 1307-1312
- Termination of very early pregnancy by RU 486 — an antiprogestational compound.Contraception. 1984; 29: 399-410
- Induction of abortion in early pregnancy with mifepristone.Gynecol Obstet Invest. 1990; 29: 13-15
- Effect of oral prostaglandin E2 on uterine contractility and outcome of treatment in women receiving RU 486 (mifepristone) for termination of early pregnancy.Hum Reprod. 1989; 4: 21-28
- Outpatient therapeutic abortion with mifepristone.Obstet Gynecol. 1989; 74: 653-657
- RU 486 (mifepristone): clinical trials in China.Acta Obstet Gynecol Scand Suppl. 1989; 149: 19-23
- Termination of early pregnancy by a single dose of mifepristone (RU 486), a progesterone antagonist.Eur J Obstet Gynecol Reprod Biol. 1988; 28: 249-255
- Experiences with the antigestagen mifepristone (RU 486) in the interruption of early pregnancy.Zentralbl Gynakol. 1989; 111: 1325-1328
- Early pregnancy interruption using an antiprogesterone steroid: mifepristone (RU 486).J Gynecol Obstet Biol Reprod (Paris). 1988; 17: 1089-1094
- Medical abortion practices: a survey of National Abortion Federation members in the United States.Contraception. 2008; 78: 486-491
- Early pregnancy termination with mifepristone and misoprostol in the United States.N Engl J Med. 1998; 338: 1241-1247
- Identification of candidates for progesterone: why, who, how, and when?.Obstet Gynecol. 2014; 123: 1317-1326
- Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin.Fertil Steril. 2008; 89: 789-792
- Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.N Engl J Med. 2003; 348: 2379-2385
- Plasma concentrations and receptor binding of RU 486 and its metabolites in humans.J Steroid Biochem. 1987; 26: 279-284
- Medical abortion outcomes following quickstart of contraceptive implants.Contraception. 2015; 91: 429
- Administration of the etonogestrel contraceptive implant on the day of mifepristone for medical abortion: a pilot study.Contraception. 2013; 88: 671-673
- Pharmacological properties of mifepristone: toxicology and safety in animal and human studies.Contraception. 2003; 68: 409-420
- Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study.BJOG. 2013; 120: 568-574
- Code of Federal Regulations, 45 CFR 46.102 (d).2009
- Legislative interference with the patient–physician relationship.N Engl J Med. 2012; 367: 1557-1559
Published online: June 06, 2015
Accepted: June 2, 2015
Received in revised form: May 27, 2015
Received: May 4, 2015
☆Conflicts of interest: none.
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.