Weighing The Options In Medical Abortion.

Abstract

For women who require interruption of pregnancy, medications that can offer a safe alternative to surgery--for example, methotrexate (though interruption of pregnancy is not an approved indication) and mifepristone (formerly known as RU486 and currently pending approval by the Food and Drug Administration [FDA])--are being examined. As with any new therapy, clinicians who wish to be able to offer this option should become familiar with the medications' safety and efficacy profiles and how they work, which patients are acceptable candidates, how the procedure is performed, how to counsel women seeking information, and how to manage complications. Nonsurgical abortion using either methotrexate or mifepristone in combination with misoprostol can be a safe and effective alternative to surgical abortion if a woman is no more than 7 weeks pregnant, clinical guidelines are followed, and access to surgical abortion is available for complications. Administration of either agent is followed within days by administration of misoprostol, a prostaglandin that induces uterine contraction and expulsion of the uterine contents. Side effects of all 3 agents are generally mild, but complications may include ongoing pregnancy, incomplete abortion, or excessive bleeding.