Module 2: Early Medical Abortion

8. Further reading and resources

Open access resources are marked with an asterisk (^*) at the beginning.

Pharmacology of medicines used for EMA

Frye, L.J., Byrne, M.E., Winikoff, B. (2016). A crossover pharmacokinetic study of misoprostol by the oral, sublingual and buccal routes. The European Journal of Contraception & Reproductive Health Care 21:265-268. Available from: https://doi.org/10.3109/13625187.2016.1168799.

Bernard, N., Elefant, E., Carlier, P., et al. (2013). Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study. BJOG 120(5):568–74. Available from: https://doi.org/10.1111/1471-0528.12147

Mark, A., Foster, A.M., Grossman, D., et al. (2019). 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 99(5):265–6. Available from: https://doi.org/10.1016/j.contraception.2019.02.008

^* Medsafe. Cytotec Data Sheet. 2019. Available from: https://www.medsafe.govt.nz/profs/Datasheet/c/Cytotectab.pdf

^* Medsafe. Mifegyne Data Sheet. 2001. Available from: https://www.medsafe.govt.nz/profs/Datasheet/m/Mifegynetab.pdf

Vauzelle, C., Beghin, D., Cournot, M.P., Elefant, E. (2013). Birth defects after exposure to misoprostol in the first trimester of pregnancy: prospective follow-up study. Reproductive toxicology 36:98–103. Available from https://doi.org/10.1016/j.reprotox.2012.11.009

^* Wiebe, E.R., Campbell, M., Aiken, A.R.A., Albert, A. (2019). Can we safely stop testing for Rh status and immunizing Rh-negative women having early abortions? A comparison of Rh alloimmunization in Canada and the Netherlands. Contracept X. 1:100001. Available from https://doi.org/10.1016/j.conx.2018.100001

^* A short video explainer (1 min 24 sec) about the action of mifepristone from Advancing New Standards in Reproductive Health (ANSIRH) is available here: https://www.youtube.com/watch?v=GknDlnjVPFM. ANSIRH is a programme within the University of California San Francisco (UCSF) Bixby Center for Global Reproductive Health and is a part of UCSF’s Department of Obstetrics, Gynecology & Reproductive Sciences.

The EMA procedure

Abbas, D., Chong, E., Raymond, E.G. (2015). Outpatient medical abortion is safe and effective through 70 days gestation. Contraception 92:197–199. Available from https://doi.org/10.1016/j.contraception.2015.06.018

Goldstone, P., Michelson, J., Williamson, E. (2012). Early medical abortion using low-dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust. 197 (5): 282–286. Available from: https://doi.org/10.5694/mja12.10297

Kaneshiro, B., Edelman, A., Sneeringer, R.K., Ponce De Leon, R.G. (2011). Expanding medical abortion: can medical abortion be effectively provided without the routine use of ultrasound? Contraception 83:194–201. Available from: https://dx.doi.org/10.1016/j.contraception.2010.07.023

Gambir, K., Kim, C., Necastro, K.A., et al. (2020). Self administered versus provider administered medical abortion. Cochrane Database of Systematic Reviews 3:CD013181. https://doi.org/10.1002/14651858.CD013181.pub2

Raymond, E.G., Shannon, C., Weaver, M.A., Winikoff, B. (2012). First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Contraception 87:26–37. Available from: https://doi.org/10.1016/j.contraception.2012.06.011

Suhonen, S., Tikka, M., Kivinen, S., Kauppila, T. (2011). Pain during medical abortion: predicting factors from gynecologic history and medical staff evaluation of severity. Contraception 83:357–61. Available from: https://dx.doi.org/10.1016/j.contraception.2010.08.006

^* von Hertzen, H., Huong, N.T., Piaggio, G., et al. (2010). Misoprostol dose and route after mifepristone for early medical abortion: a randomised controlled noninferiority trial. BJOG 117:1186–1196. Available from: https://dx.doi.org/10.1111/j.1471-0528.2010.02636.x

Zhang, J., Zhou, K., Shan, D., Luo, X. (2022). Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews 5:CD002855. https://doi.org/10.1002/14651858.CD002855.pub5

Follow up care and management of complications

Baiju, N., Acharya, G., D’Antonio, F., Berg, R.C. (2019). Effectiveness, safety and acceptability of self-assessment of the outcome of first-trimester medical abortion: A systematic review and meta-analysis. BJOG 126(13):1536–1544. Available from: https://doi.org/10.1111/1471-0528.15922

Grossman, D., & Grindlay, K. (2011). Alternatives to ultrasound for follow-up after medication abortion: A systematic review. Contraception 83(6):504–510. Available from: https://doi.org/10.1016/j.contraception.2010.08.023

Kerns , J.L., Brown, K., Nippita, S., Steinauer, J. (2023). Society of Family Planning Clinical Recommendation: Management of hemorrhage at the time of abortion. Contraception. Available online 20 September 2023, 110292. Available from https://doi.org/10.1016/j.contraception.2023.110292

Pocius KD, Maurer R, Fortin J, Goldberg AB, Bartz D. (2015). Early serum human chorionic gonadotropin (hCG) trends after medication abortion. Contraception 91:503–506. Available from: https://dx.doi.org/10.1016/j.contraception.2015.03.004

Raymond, E. G., Shochet, T., Bracken, H. (2018). Low-sensitivity urine pregnancy testing to assess medical abortion outcome: A systematic review. Contraception 98(1):30–35. Available from: https://doi.org/10.1016/j.contraception.2018.03.013

Schmidt-Hansen, M., Cameron, S., Lohr, P.A., Hasler, E. (2020). Follow-up strategies to confirm the success of medical abortion of pregnancies up to 10 weeks’ gestation: A systematic review with meta-analyses. AJOG 222:551–563.e13. Available from: https://doi.org/10.1016/j.ajog.2019.11.1244

Patient support

Aamlid, I.B., Dahl, B., Sommerseth, E. (2021). Women’s experiences with information before medication abortion at home, support during the process and follow-up procedures—A qualitative study. Sexual & Reproductive Healthcare 27:100582. Available from https://doi.org/10.1016/j.srhc.2020.100582

Mahanaimy, M., Gerdts, C., Moseson, H. (2022). What constitutes a good healthcare experience for unintended pregnancy? A qualitative study among young people in California. Culture, Health & Sexuality 24:330–343. Available from https://doi.org/10.1080/13691058.2020.1840631

^* Purcell, C., Cameron, S., Lawton, J., et al (2017). Self‐management of first trimester medical termination of pregnancy: A qualitative study of women’s experiences. BJOG 124:2001–2008. Available from: https://doi.org/10.1111/1471-0528.14690