Module IV: Medication Abortion up to 28 Weeks Gestation
Module Review Information
The resources in this module were reviewed by Sarah Averbach, MD, MAS, and Sarita Sonalkar, MD, MPH, in Spring 2025.
Learning Objectives
- Understand the mechanism, pharmacokinetics, and efficacy of medication abortion agents (mifepristone, misoprostol).
- Describe the evidence-based dosing regimens of medication abortion.
- Counsel patients about eligibility, pain management, side effects, and risks of medication abortion.
- Provide post-procedure care for patients who undergo medication abortion.
Articles
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology, Society of Family Planning. Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225.
Obstet Gynecol
. 2020;136(4):e31-e47. doi:
10.1097/AOG.0000000000004082
Gestation.
FDA
. Published online March 24, 2023. Accessed April 5, 2023.
https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation
Dzuba IG, Chong E, Hannum C, et al. A Non-Inferiority Study of Outpatient Mifepristone-Misoprostol Medical Abortion at 64-70 Days and 71-77 Days of Gestation.
Contraception
. 2020;101(5):302-308. doi:
10.1016/j.contraception.2020.01.009
Grossman D, Verma N. Self-managed Abortion in the US.
JAMA
. 2022;328(17):1693-1694. doi:
10.1001/jama.2022.19057
Brandell K, Jar-Allah T, Reynolds-Wright J, et al. Randomized Trial of Very Early Medication Abortion.
New England Journal of Medicine
. 2024;391(18):1685-1695. doi:
10.1056/NEJMoa2401646
ACOG Clinical Practice Update: Rh D Immune Globulin Administration After Abortion or Pregnancy Loss at Less Than 12 Weeks of Gestation.
Obstetrics & Gynecology
. 2024;144(6):e140. doi:
10.1097/AOG.0000000000005733
Zwerling B, Edelman A, Jackson A, Burke A, Prabhu with the assistance of M. Society of Family Planning Clinical Recommendation: Medication abortion between 14 0/7 and 27 6/7 weeks of gestation: Jointly developed with the Society for Maternal-Fetal Medicine.
Contraception
. 2024;129:110143. doi:
10.1016/j.contraception.2023.110143
Trending Topics
Du L, Li HWR, Gemzell-Danielsson K, et al. Comparing letrozole and mifepristone pre-treatment in medical management of first trimester missed miscarriage: a prospective open-label non-inferiority randomised controlled trial.
BJOG: An International Journal of Obstetrics & Gynaecology
. 2024;131(3):319-326. doi:
10.1111/1471-0528.17646
Winikoff B, Bousiéguez M, Salmerón J, et al. A Proof-of-Concept Study of Ulipristal Acetate for Early Medication Abortion.
NEJM Evidence
. 2025;4(2):EVIDoa2400209. doi:
10.1056/EVIDoa2400209
Supplemental Resources
Meckstroth KR, Whitaker AK, Bertisch S, Goldberg AB, Darney PD. Misoprostol Administered by Epithelial Routes: Drug Absorption and Uterine Response.
Obstet Gynecol
. 2006;108(3 Pt 1):582-590. doi:
10.1097/01.AOG.0000230398.32794.9d