ACOG has reaffirmed guidance related to medication abortion up until 70 days of gestation. This guidance impacts multiple aspects of gynecologic care. Approximately 60% of abortions will occur before 10 weeks with current data suggesting that medication abortion constitutes 39% of all abortions. Combined mifepristone-misoprostol regimens are preferred due to increased effectiveness vs misoprostol only. Mifepristone is a selective progesterone receptor modulator and misoprostol is a prostaglandin E1 analogue.
Confirm Pregnancy and Estimate Gestational Age
Other Laboratory Evaluations
Alternative: Mifepristone unavailable
Counsel Patients Regarding the Following
Need for Uterine Aspiration Due to Ongoing Pregnancy or Retained Tissue
Note: Management choices based on clinical situation and patient preference
Note: ACOG has released a Practice Advisory on mifepristone and the FDA Risk Evaluation and Mitigation Strategy (REMS)
The FDA has permanently removed the in-person dispensing requirement and added a new pharmacy certification process, which will enable retail pharmacies that meet certain qualifications to dispense mifepristone directly to patients who have a prescription from a certified prescriber
All other previous mifepristone REMS requirements remain in effect, including the need for prescriber certification and completion of Prescriber and Patient Agreement Forms
ACOG Practice Bulletin 225: Medication Abortion Up to 70 Days of Gestation
ACOG: Updated Mifepristone REMS Requirements
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