Keywords
1. Introduction
- Zhang J.
- Zhou K.
- Shan D.
- Luo X.
- Blum J.
- Raghavan S.
- Dabash R.
- Ngoc N.
- Chelli H.
- Hajri S.
- et al.
- Ngoc N.T.
- Blum J.
- Raghavan S.
- Nga N.T.
- Dabash R.
- Diop A.
- et al.
- Shochet T.
- Turok D.
- Frye L.J.
- Sexsmith C.D.
- Gawron L.M.
- Kaiser J.E.
- et al.
- Jayaweera R.T.
- Moseson H.
- Gerdts C.
Royal College of Obstetricians and Gynaecologists. Best practice in abortion care. London, England; 2022. https://www.rcog.org.uk/media/geify5bx/abortion-care-best-practice-paper-april-2022.pdf.
2. Data on effectiveness and safety of misoprostol-only regimens
- Ngoc N.T.
- Blum J.
- Raghavan S.
- Nga N.T.
- Dabash R.
- Diop A.
- et al.
- Blum J.
- Raghavan S.
- Dabash R.
- Ngoc N.
- Chelli H.
- Hajri S.
- et al.
- Ngoc N.T.
- Blum J.
- Raghavan S.
- Nga N.T.
- Dabash R.
- Diop A.
- et al.
3. Sample protocol

3.1 Patient selection
3.2 Rh typing and other pretreatment laboratory testing
Royal College of Obstetricians and Gynaecologists. Best practice in abortion care. London, England; 2022. https://www.rcog.org.uk/media/geify5bx/abortion-care-best-practice-paper-april-2022.pdf.
3.3 Treatment regimen
3.4 Symptom management
- Blum J.
- Raghavan S.
- Dabash R.
- Ngoc N.
- Chelli H.
- Hajri S.
- et al.
- Ngoc N.T.
- Blum J.
- Raghavan S.
- Nga N.T.
- Dabash R.
- Diop A.
- et al.
3.5 Follow-up
3.6 Management of treatment failures
4. Patient education

5. Conclusion
Acknowledgment
References
- Abortion incidence and service availability in the United States, 2020.Perspect Sex Reprod Health. 2022; 54: 128-141https://doi.org/10.1363/psrh.12215
- Abortion through telemedicine.Curr Opin Obstet Gynecol. 2018; 30: 394-399https://doi.org/10.1097/GCO.0000000000000498
- Medical methods for first trimester abortion.Cochrane Database Syst Rev. 2022; 5CD002855https://doi.org/10.1002/14651858.CD002855.pub5
- Comparison of misoprostol-only and combined mifepristone-misoprostol regimens for home-based early medical abortion in Tunisia and Vietnam.Int J Gynaecol Obstet. 2012; 118 (https://doi.org/10.1016/j.ijgo.2012.03.039 S0020-7292(12)00215-9 [pii]): 166-171
- A prospective randomized, double-blinded, placebo-controlled trial comparing mifepristone and vaginal misoprostol to vaginal misoprostol alone for elective termination of early pregnancy.Hum Reprod. 2002; 17: 1477-1482
- Comparing two early medical abortion regimens: mifepristone+misoprostol vs. misoprostol alone.Contraception. 2011; 83 (https://doi.org/S0010-7824(10)00522-6 [pii]): 410-417https://doi.org/10.1016/j.contraception.2010.09.002
- Efficacy and safety of mifepristone and buccal misoprostol versus buccal misoprostol alone for medical abortion.Arch Gynecol Obstet. 2012; 285: 1055-1058https://doi.org/10.1007/s00404-011-2110-8
- Comparison of abortions induced by methotrexate or mifepristone followed by misoprostol.Obstet Gynecol. 2002; 99: 813-819https://doi.org/10.1016/s0029-7844(02)01944-0
- Methotrexate and misoprostol for early abortion: a multicenter trial. I. Safety and efficacy.Contraception. 1996; 53 (https://doi.org/0010782496000807 [pii]): 321-327
- Early medical abortion with methotrexate and misoprostol.Obstet Gynecol. 2001; 97 (https://doi.org/S0029-7844(00)01090-5 [pii]): 11-16
- Mifepristone and misoprostol and methotrexate/misoprostol in clinical practice for abortion.Am J Obstet Gynecol. 2003; 188 (https://doi.org/S0002937802714610 [pii]): 664-669
- A pilot study on the use of letrozole with either misoprostol or mifepristone for termination of pregnancy up to 63 days.Contraception. 2011; 83: 62-67https://doi.org/10.1016/j.contraception.2010.05.014
- Misoprostol with or without letrozole pretreatment for termination of pregnancy: a randomized controlled trial.Obstet Gynecol. 2011; 117: 317-323https://doi.org/10.1097/AOG.0b013e3182073fbf
- A pilot study on the use of a 7-day course of letrozole followed by misoprostol for the termination of early pregnancy up to 63 days.Contraception. 2012; 86: 763-769https://doi.org/10.1016/j.contraception.2012.05.009
- Single dose letrozole and misoprostol for termination of pregnancy through 63 days’ gestation: a pilot study.Contraception. 2022; 109924https://doi.org/10.1016/j.contraception.2022.109924
- Misoprostol in the era of COVID-19: a love letter to the original medical abortion pill.Sex Reprod Health Matters. 2020; 281829406https://doi.org/10.1080/26410397.2020.1829406
- Abortion care guideline. World Health Organization, Geneva, Switzerland2022
- Medical abortion.J Obstet Gynaecol Can. 2016; 38: 366-389https://doi.org/10.1016/j.jogc.2016.01.002
- Clinical policy guidelines. National Abortion Federation, Washington, DC2022
Royal College of Obstetricians and Gynaecologists. Best practice in abortion care. London, England; 2022. https://www.rcog.org.uk/media/geify5bx/abortion-care-best-practice-paper-april-2022.pdf.
- Efficacy of misoprostol alone for first-trimester medical abortion: a systematic review.Obstet Gynecol. 2019; 133: 137-147https://doi.org/10.1097/AOG.0000000000003017
- Mifepristone with buccal misoprostol for medical abortion: a systematic review.Obstet Gynecol. 2015; 126: 12-21https://doi.org/10.1097/AOG.0000000000000897
- First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review.Contraception. 2013; 87: 26-37https://doi.org/10.1016/j.contraception.2012.06.011
- Early abortion with buccal versus sublingual misoprostol alone: a multicenter, randomized trial.Contraception. 2019; 99: 272-277https://doi.org/10.1016/j.contraception.2019.02.002
- Oral and vaginal misoprostol 800 microg every 8h for early abortion.Contraception. 2003; 67: 457-462https://doi.org/10.1016/s0010-7824(03)00043-x
- A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 h for medical termination of pregnancies up to eight weeks.BJOG. 2003; 110: 175-180
- Building bridges: a case for community health worker provision of misoprostol-only abortion in the first trimester.J Womens Health. 2018; 27: 311-316https://doi.org/10.1089/jwh.2016.6144
- Misoprostol as the primary agent for medical abortion in a low-income urban setting.Contraception. 2004; 70: 121-126https://doi.org/10.1016/j.contraception.2004.03.007
- Efficacy of two intervals and two routes of administration of misoprostol for termination of early pregnancy: a randomised controlled equivalence trial.Lancet. 2007; 369: 1938-1946https://doi.org/10.1016/S0140-6736(07)60914-3
- Early pregnancy termination with vaginal misoprostol before and after 42 days gestation.Hum Reprod. 2002; 17: 3079-3083https://doi.org/10.1093/humrep/17.12.3079
- Efficacy and safety of very early medical termination of pregnancy: a cohort study.BJOG. 2017; 124: 1993-1999https://doi.org/10.1111/1471-0528.14904
- Effectiveness of early medical abortion using low-dose mifepristone and buccal misoprostol in women with no defined intrauterine gestational sac.Contraception. 2013; 87: 855-858https://doi.org/10.1016/j.contraception.2012.10.013
- Mifepristone and misoprostol for early abortion when no gestational sac is present.Contraception. 2001; 63: 251-254
- Mifepristone and misoprostol for undesired pregnancy of unknown location.Obstet Gynecol. 2022; 139: 771-780https://doi.org/10.1097/AOG.0000000000004756
- Community-based distribution of misoprostol for early abortion: evaluation of a program along the Thailand-Burma border.Contraception. 2017; 96: 242-247https://doi.org/10.1016/j.contraception.2017.06.006
- Community-based distribution of misoprostol for early abortion: outcomes from a program in Sindh, Pakistan.Contraception. 2022; 109: 49-51https://doi.org/10.1016/j.contraception.2022.01.005
- Effectiveness of self-managed medication abortion with accompaniment support in Argentina and Nigeria (SAFE): a prospective, observational cohort study and non-inferiority analysis with historical controls.Lancet Glob Health. 2022; 10: e105-e113https://doi.org/10.1016/S2214-109X(21)00461-7
- Sublingual misoprostol for first trimester termination of pregnancy.Int J Gynaecol Obstet. 2010; 109: 67-70https://doi.org/10.1016/j.ijgo.2009.11.008
- Mifepristone plus vaginal misoprostol vs vaginal misoprostol alone for medical abortion in gestation 63 days or less in Nepalese women: a quasi-randomized controlled trial.J Obstet Gynaecol Res. 2009; 35: 78-85https://doi.org/10.1111/j.1447-0756.2008.00864.x
- A comparison of tamoxifen and misoprostol to misoprostol alone for early pregnancy termination.Contraception. 1999; 60: 353-356https://doi.org/10.1016/s0010-7824(99)00105-5
- Commentary: No-test medication abortion: a sample protocol for increasing access during a pandemic and beyond.Contraception. 2020; 101: 361-366https://doi.org/10.1016/j.contraception.2020.04.005
- Outcomes and safety of history-based screening for medication abortion: a retrospective multicenter cohort study.JAMA Intern Med. 2022; 182: 482-491https://doi.org/10.1001/jamainternmed.2022.0217
- Foregoing Rh testing and anti-D immunoglobulin for women presenting for early abortion: a recommendation from the National Abortion Federation’s Clinical Policies Committee.Contraception. 2019; 99: 265-266https://doi.org/10.1016/j.contraception.2019.02.008
- 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: 1-6https://doi.org/10.1016/j.contraception.2020.02.011
- Society of Family Planning committee consensus on Rh testing in early pregnancy.Contraception. 2022; 114: 1-5https://doi.org/10.1016/j.contraception.2022.07.002
- Ibuprofen and paracetamol for pain relief during medical abortion: a double-blind randomized controlled study.Fertil Steril. 2009; 91: 1877-1880https://doi.org/10.1016/j.fertnstert.2008.01.084
- Transcutaneous electrical nerve stimulation to reduce pain with medication abortion: a randomized controlled trial.Obstet Gynecol. 2021; 137: 100-107https://doi.org/10.1097/AOG.0000000000004208
- Two prophylactic pain management regimens for medical abortion ≤63 days’ gestation with mifepristone and misoprostol: a multicenter, randomized, placebo-controlled trial.Contraception. 2021; 103: 163-170https://doi.org/10.1016/j.contraception.2020.12.004
- Early pregnancy termination with vaginal misoprostol combined with loperamide and acetaminophen prophylaxis.Contraception. 2001; 63: 217-221
- Misoprostol exposure during the first trimester of pregnancy: Is the malformation risk varying depending on the indication.Eur J Obstet Gynecol Reprod Biol. 2016; 207: 188-192https://doi.org/10.1016/j.ejogrb.2016.11.007
- Birth defects after exposure to misoprostol in the first trimester of pregnancy: prospective follow-up study.Reprod Toxicol. 2013; 36: 98-103https://doi.org/10.1016/j.reprotox.2012.11.009
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Footnotes
☆Declaration of Competing Interest: MDC is a consultant for Danco Laboratories.
☆☆Funding: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.