Mifepristone For Medical Abortion Research Articles

Pharmacist checklist and resource guide for mifepristone medical abortion: User-centred development and testing.

Pharmacist checklist and resource guide for mifepristone medical abortion: User-centred development and testing.

Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study.

Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada. We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory. We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice. Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.

Explaining slow implementation of mifepristone in Quebec with the transtheoretical model of change

<h3>Objectives</h3> Mifepristone for first-trimester medical abortion (MA) became available in Quebec in 2018, one year after the rest of Canada. Using the transtheoretical model of change (TTM), we investigated factors influencing the implementation of mifepristone MA by physicians in Quebec. <h3>Methods</h3> Semi-structured interviews were conducted with 37 Quebec physicians in early 2018. Deductive thematic analysis guided by the TTM explored facilitators and barriers to physicians' adoption of mifepristone MA. We classified participants into five stages of mifepristone adoption based on the TTM. Follow-up data collection one year later assessed further adoption. <h3>Results</h3> At baseline, three physicians provided mifepristone MA (Maintenance) and two were about to start (Action). Fifteen physicians at Preparation and Contemplation stages intended to start while ten were unsure (Slow Contemplation) and seven did not intend to provide (Pre-Contemplation). Barriers such as complexity of local health care organizations, uncertainty/confusion about medical policy restrictions, and uncertainty about organizational flexibility were present at all stages. Availability of surgical abortion services was a barrier for participants in the Contemplation and Pre-contemplation stages while the presence of a surgical culture was mentioned by participants in the Maintenance and Action stages. One year later, ten physicians provided MA (including the three at baseline), with a range of 3 to 50 prescriptions per provider. Seventeen either lost their intention or never intended to start provision. <h3>Conclusions</h3> Despite ideological support, mifepristone MA uptake in Quebec is slow and laborious, mainly due to restrictive medical policies, resistance to abortion practice diversification and administrative inertia.

Development and testing for a national survey: The Canadian Abortion Provider Survey (CAPS)

Objectives To create a questionnaire able to explore changes in abortion services, workforce, and clinical practices compared to our 2012 Canadian survey, particularly in relationship to the 2017 introduction of mifepristone medical abortion and updated SOGC clinical guidelines. We aimed to create a cross-sectional online survey capturing demographics, clinical care and provider experiences among healthcare professionals providing abortion care either independently or in collaborative care agreements. Methods After completing a literature search, we held expert working-group meetings to revise the 2012 survey instrument. We convened expert focus groups across Canada engaging clinicians and researchers from many sectors, and subsequently piloted the survey instrument. Results We held 7 expert working groups of 5–10 participants each. Input from participants including family physicians, obstetricians & gynaecologists, maternal–fetal–medicine specialists, midwives, nurses, and researchers ensured relevant and concise questions. Due to the complexity of some of the identified topics, such as interdisciplinary collaboration and differences between provinces, some of the survey sections underwent an iterative process of meetings and revisions until we reached consensus on constructs to include. The resulting instrument underwent pilot testing among additional experts representing the study population. We confirmed content validity, clarity of language and usability of the survey instrument. Conclusions The new national survey instrument is the product of a rigorous revision and testing process. We plan to implement the survey in 2020 to assess practice factors and their relationship to recent SOGC guidelines. To create a questionnaire able to explore changes in abortion services, workforce, and clinical practices compared to our 2012 Canadian survey, particularly in relationship to the 2017 introduction of mifepristone medical abortion and updated SOGC clinical guidelines. We aimed to create a cross-sectional online survey capturing demographics, clinical care and provider experiences among healthcare professionals providing abortion care either independently or in collaborative care agreements. After completing a literature search, we held expert working-group meetings to revise the 2012 survey instrument. We convened expert focus groups across Canada engaging clinicians and researchers from many sectors, and subsequently piloted the survey instrument. We held 7 expert working groups of 5–10 participants each. Input from participants including family physicians, obstetricians & gynaecologists, maternal–fetal–medicine specialists, midwives, nurses, and researchers ensured relevant and concise questions. Due to the complexity of some of the identified topics, such as interdisciplinary collaboration and differences between provinces, some of the survey sections underwent an iterative process of meetings and revisions until we reached consensus on constructs to include. The resulting instrument underwent pilot testing among additional experts representing the study population. We confirmed content validity, clarity of language and usability of the survey instrument. The new national survey instrument is the product of a rigorous revision and testing process. We plan to implement the survey in 2020 to assess practice factors and their relationship to recent SOGC guidelines.

Barriers and Facilitators to the Implementation of First Trimester Medical Abortion With Mifepristone in the Province of Québec: A Qualitative Investigation.

Mifepristone became available in Canada in January 2017, but provincial medical policy delayed its use for medical abortion (MA) in Québec for 1 year. The objective of this study was to identify barriers and facilitators experienced by physicians who could potentially provide this newer abortion practice in Québec. This study was part of the Canadian Contraception and Abortion Research Team-Mifepristone Implementation Study, an observational, prospective, mixed-methods study. Interviews were conducted with physicians representing all health regions of Québec. Using thematic analysis guided by diffusion of innovation theory, the study identified key barriers and facilitators to implementation. From January 2017 to March 2018, study investigators interviewed 25 family physicians and 12 obstetrician-gynaecologists. Most were women (81%), over 40 years old (65%), with >20 years in practice since residency (49%). Less than half of the sample provided abortion services (41%), and only 8% provided MA with mifepristone. Key barriers to implementation were: (1) uncertainty or confusion about policies regarding MA, (2) lack of human resources or support from colleagues, (3) uncertainty about product distribution, (4) confusion about professional collaboration, and (5) lack of local infrastructure. Key facilitators were: (1) perception of support and influence from colleagues, (2) previous experience with provision of first trimester MA, (3) requests for first trimester MA by patients or other physicians, and (4) knowledge of research on mifepristone MA. Despite Health Canada's approval of mifepristone in Canada and supportive federal policies for provision of MA in primary care, physicians in the province of Québec face onerous barriers to the practice of mifepristone MA.

Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers

BackgroundDirect primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada.MethodsIn phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh’s conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin’s framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré’s validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility.ResultsWe developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada.ConclusionsOur team operationalized Greenhalgh’s theoretical framework for Diffusion of Innovations in health systems to explore factors influencing the implementation of first-trimester medical abortion provision. This process may be useful for those evaluating other health system innovations. Identification of facilitators and barriers to implementation of mifepristone practice in Canada and knowledge translation has the potential to inform regulatory and health system changes to support and scale up facilitators and mitigate barriers to equitable medical abortion provision.

Safety of Mifepristone in Medical Abortion in Hyperthyroidism Pregnant Mice

Objective: To study the safety of mifepristone on thyroid hormone level by using hyperthyroidism pregnant model in mouse to simulate the process of medical abortion and observe the changes of thyroid hormone during abortion. Methods: A total of 60 female Institute of Cancer Research (ICR) mice aged 6–8 weeks were divided into control group, control group with 0 mgRU486 group (control-0 mgRU486), control group with 2 mgRU486 group (control-2 mgRU486), hyperthyroid pregnant mice with 0 mgRU486 group (hyper-0 mgRU486), hyperthyroid pregnant mice with 2 mgRU486 group (hyper-2 mgRU486), and hyperthyroid pregnant mice with 20 mgRU486 group (hyper-20 mgRU486). In the hyperthyroidism groups, L-thyroxine sodium was intraperitoneally injected every day at 30 μg·kg−1·day−1 until the end of the experiment. On the 7th day of the experiment, free triiodothyronine (FT3), free tetraiodothyroxine (FT4), thyroxine (TT4), and thyroid-stimulating hormone (TSH) levels were tested. The mice in the control groups and those in the experimental groups were paired with the male mice (2:1) on the 10th day of the experiment, and the caging was recorded. On the 8th day of pregnancy (day 8), pregnant mice were subcutaneously injected with mifepristone in different doses and were sacrificed 6 h later. Pregnancy rate and the number of embryos were recorded. Thyroid tissues were observed by hematoxylin and eosin (HE) staining. Serum TSH level was determined by radioimmunoassay. Results: Six hours after injection with mifepristone, serum FT3, FT4, and TT4 levels of pregnant mice were all increased. The increased levels in the mice under hyperthyroidism were different from those in the control groups (P < 0.05). There was no difference in the embryo number and pregnancy rate between the experimental and the control groups; HE staining indicated that there was no significant change in microscopic features before and after mifepristone administration. Conclusion: Serum thyroid hormone level of mice under hyperthyroidism was significantly increased after mifepristone administration. Therefore, mifepristone should be avoided when hyperthyroidism has not been controlled.

Progestin-based contraceptive on the same day as medical abortion.

To determine the success rate of medical abortion when a progestin-based contraceptive-either an etonogestrel implant or depot medroxyprogesterone acetate (DMPA) injection-is given on the same day as mifepristone for medical abortion. In a retrospective chart review, data were assessed for women aged 15-49years who underwent medical abortion (≤63days of pregnancy) at two hospitals in KwaZulu Natal, South Africa, between August 2013 and July 2014. The women were given oral mifepristone (200mg) and buccal misoprostol (800μg), and received an etonogestrel implant or DMPA injection on the same day as mifepristone. The primary outcome was the success rate of medical abortion. Comparative data were obtained through a PubMed search. A total of 89 women were included. Complete termination was achieved in 87 (98%, 95% confidence interval 95%-100%) women. This success rate is similar to that reported in a previous systematic review of the rate of medical abortion success without progestin contraceptive administration (94.8%). Administration of a progestin-based contraceptive such as an etonogestrel implant or DMPA injection on the same day as mifepristone for medical abortion did not alter the success rates.

Early versus late misoprostol administration after mifepristone for medical abortion.

To evaluate the successful medical termination of pregnancy comparing two regimens: misoprostol 2 or 48 h after mifepristone administration. Prospective randomized study. Department of Obstetrics and Gynecology. One hundred pregnant women admitted for medical termination of pregnancy were enrolled; no pregnancies were over 55 days gestational age. All subjects were randomly assigned for misoprostol administration either 2 or 48 h after mifepristone. All participants underwent transvaginal ultrasound examination for uterine contents 48 h and 3 weeks after mifepristone. Procedure failure, defined as the presence of fetal heart activity, presence of a gestational sac, or a need for uterine curettage after misoprostol administration. Each group consisted of 50 women. Fetal heart activity was significantly more frequent after 48 h in the 2-h interval group (10/50) than in the 48-h interval group (0/50) (p = 0.002). Three weeks after misoprostol administration, fetal heart activity was present in 4/50 (8 %) in the 2-h interval group (p = 0.118) and none of the 48-h interval group. At 48 h residual tissue was present in 13/50 (26 %) and 5/50 (10 %) in the 2 and 48-h interval groups, respectively (p = 0.031); this was reduced to 12/50 (24 %) compared to 5/50 (10 %) in the two groups, respectively (p = 0.054) after 3 weeks. Successful medical termination of pregnancy can be achieved using misoprostol administration 2 h after mifepristone in 76 % of cases. However, this regimen is not recommended as it is significantly inferior to the traditional 48-h interval regimen.

Acceptability and feasibility of mifepristone medical abortion in the early first trimester in Azerbaijan

Objective To examine the acceptability and feasibility of early medical abortion using mifepristone and misoprostol in Azerbaijan.Methods A total of 863 women in Baku and two regions of Azerbaijan who sought termination of gestations up to 63 days were enrolled in the study. In the capital, women swallowed 200 mg mifepristone in the clinic and were given the option of taking 800 μg misoprostol buccally either at the clinic or at home 24–48 hours later. In the regions, women were given the option of taking both drugs at home. Follow-up visits were to take place two weeks after mifepristone administration to determine abortion status.Results Seventy-four percent of women in the regions chose home administration of mifepristone, and 92% of women from all locations selected misoprostol home administration. Ninety-seven percent of women had complete abortions, and 97% were satisfied or very satisfied with the method. The vast majority of participants preferred medical abortion for a future procedure (96%). Nearly all women (98%) would recommend medical abortion for pregnancy termination to a friend.Conclusion Mifepristone-misoprostol medical abortion with the option of home administration of both drugs is an acceptable and feasible option for women in Azerbaijan.Chinese 摘要 目的 研究阿塞拜疆妇女对应用米非司酮米索前列醇进行早期妊娠药物流产的可接受性及可行性。方法 研究选取在阿塞拜疆首都巴库以及两个地区的要求终止63天内妊娠的863名妇女。在巴库，流产妇女在门诊口服200mg的米非司酮，24-48小时后她们可以选择在门诊或在家舌下含服800ug的米索前列醇。在阿塞拜疆的两个地区这两种药物妇女都可以选择在家服用。服用米非司酮后两周进行随访，以判断流产的状况。结果 阿塞拜疆两个地区的74%的妇女选择在家服用米非司酮，所有入选妇女的92%都选择了在家服用米索前列醇。所有药物流产中，完全流产率为97%。97%的妇女对这种流产方法表示满意或非常满意，绝大部分的妇女（96%）表示以后会优先选择这种方法，几乎所有的妇女（98%）愿意把这种流产的方法介绍给她们的朋友。结论 在阿塞拜疆，让妇女选择在家里使用米非司酮-米索前列醇进行药物流产是可以接受的也是可行的。

A two-pill sublingual misoprostol outpatient regimen following mifepristone for medical abortion through 70 days' LMP: a prospective comparative open-label trial

ObjectiveTo test the effectiveness and acceptability of an outpatient medical abortion protocol with 200 mg mifepristone and 400 mcg sublingual misoprostol at 64–70 days' last menstrual period (LMP) and compare it to the already known efficacy of the 57–63 days' LMP gestational age range. Study DesignWe conducted a prospective, comparative open-label trial in six hospitals and clinics in Ukraine, Georgia, India and Tunisia. We enrolled 714 reproductive age women with pregnancies 57 to 70 days who presented requesting abortion. Medical abortions were managed with the current service delivery protocol (200 mg oral mifepristone followed in 24–48 h by 400 mcg sublingual misoprostol). Data on safety, efficacy and acceptability were collected. The main outcome measure was complete abortion without surgical intervention at any point. ResultsA total of 703 cases were analyzable for efficacy. Success rates did not differ significantly in the two groups [57–63-day group: 94·8%; 64–70-day group: 91.9%; Relative Risk (RR): 0.79 (0.61–1.04)]. Ongoing pregnancy rates also did not differ significantly (57–63 days: 1.8%; 64–70 days: 2.2%; RR: 1.10 (0.65–1.87)]. ConclusionA medical abortion regimen of 200 mg mifepristone followed in 24–48 h by 400 mcg sublingual misoprostol is effective through 70 days' gestation and may be offered within existing outpatient abortion services. ImplicationsA regimen of 200 mg mifepristone followed in 24–48 h by 400 mcg sublingual misoprostol is effective up to 70 days' LMP. The findings have important implications for expanding access to outpatient medical abortion services in settings where the cost of misoprostol is of concern or a two-pill misoprostol regimen is the standard of care.

Acceptability and feasibility of the use of 400 μg of sublingual misoprostol after mifepristone for medical abortion up to 63 days since the last menstrual period: Evidence from Uzbekistan

ABSTRACTObjective To examine the efficacy, acceptability and feasibility of early medical abortion, with the option of home administration of misoprostol, in Uzbekistan.Methods A total of 450 women were enrolled at national, municipal and private facilities in Tashkent, Uzbekistan. Women who presented for termination of pregnancy with gestations up to 63 days were recruited to participate in the study. All eligible pregnant women who consented to participate swallowed a 200 mg mifepristone pill in the clinic and were given the option of taking 400 μg misoprostol sublingually either at the clinic or at home 24–48 hours after mifepristone administration. Abortion status was determined two weeks later.Results Almost all women (99.5%) chose home administration of misoprostol. The sublingual route of misoprostol administration was acceptable or very acceptable to 89% of participants. Ninety-five percent of women had complete abortions after mifepristone and misoprostol. Almost all participants preferred a medical abortion to surgery for a future procedure (95%).Conclusions Mifepristone medical abortion with home administration of misoprostol is an acceptable and feasible option for women in Uzbekistan. The method worked well at all three facility types.

A randomized controlled trial of different buccal misoprostol doses in mifepristone medical abortion

BackgroundAn 800-mcg dose of buccal misoprostol following mifepristone has been shown to be highly effective in terminating pregnancies through 63 days since the last menstrual period (LMP) (B. Winikoff, I.G. Dzuba, M.D. Creinin, et al., Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial. Obstet Gynecol 2008; 112: 1303–1310). However, a two 200-mcg misoprostol pill option would simplify administration, and potentially reduce costs and increase women's satisfaction. This study compares a 400-mcg dose (Group I) to an 800-mcg dose (Group II) of buccal misoprostol. Study DesignEligible and consenting women requesting medical termination of early pregnancy (n=1122) were randomized and instructed to take misoprostol 36 to 48 h after taking 200 mg mifepristone. Follow-up visits occurred 12 to 15 days after mifepristone administration. ResultsNinety-six percent of women in both groups had successful abortions. Women in Group I experienced significantly less vomiting and fever/chills than women in Group II. Ninety-six percent of women in both groups found the procedure very satisfactory or satisfactory. ConclusionsFour hundred micrograms of buccal misoprostol is as effective as the standard 800-mcg dose in terminating pregnancies up to 63 days LMP and reduces side effects.

Mifepristone Medical Abortion

Mifepristone Medical Abortion

Mifepristone Medical Abortion

Dr. Hertz is Clinical Associate Professor, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, 3990 John R, 7 Brush North, Mailbox # 166, Detroit, MI 48201. E-mail: [email protected]. Dr. Hertz has disclosed that the use of misoprostol as discussed in this article has not been approved by the U.S. Food and Drug Administration. All faculty and staff in a position to control the content of this CME activity, and their spouses/partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This activity expires on February 14, 2013.

Mifepristone followed by home administration of buccal misoprostol for medical abortion up to 70 days of amenorrhoea in a general practice in Curaçao

Objective To evaluate the efficacy and safety of home administration of buccal misoprostol after mifepristone for medical abortion up to 70 days' gestation in a general practice in Curaçao, where induced abortion is severely restricted by law.Methods In a prospective study 330 women received 200 mg mifepristone and were instructed to take four tablets (800 μg) of misoprostol via the buccal route 24–36 h later, at home. One week later, follow-up took place.Results The outcome could be evaluated in 307 of the 330 women. The efficacy of the mifepristone-buccal misoprostol procedure was 97.7% (300/307). In seven women vacuum aspirations for continuing pregnancy or incomplete abortion following treatment were required. Success rates at 64–70 days' gestation were the same as for gestations of less than 64 days duration. The main adverse effects were nausea and diarrhoea.Conclusion Home administration of buccal misoprostol 24–36 h after mifepristone is a safe and effective method of medical abortion up to 70 days. It could be applied in a general practice in Curaçao, where induced abortion is legally restricted.

Use of mifepristone for medical abortion in Australia, 2006–2009

Use of mifepristone for medical abortion in Australia, 2006–2009

Has mifepristone medical abortion expanded abortion access in New Mexico? A survey of OB-GYN and Family Medicine physicians

Background The FDA approval of mifepristone in 2000 broadened the available options for abortion. The aim of this study was to evaluate whether physicians in New Mexico have integrated the use of mifepristone into their practice. Study Design We performed a mail-out survey of New Mexico Obstetrician Gynecologists (Ob-Gyn) and Family Medicine (FM) physicians in 2001 and 2008. Questions addressed integration of abortion services, attitudes towards providing abortion in different scenarios and barriers to offering abortion services. Results The response rates were 59% for the 2001 survey and 54% in 2008. In 2001 and 2008, 11% and 15% (p=.26) of physicians, respectively, provided any abortion — medical or surgical. Similarly, in 2001 and 2008, 5% and 10% (p=.07) provided medical abortion. Commonly cited barriers to provision of abortion in both years were beliefs against abortion and lack of training. Conclusions The number of physicians offering any abortion or medical abortion in New Mexico has not changed since the FDA approval of mifepristone. Residency training programs in FM and in Ob-gyn should include training in medical abortion.

Comparing two early medical abortion regimens: mifepristone+misoprostol vs. misoprostol alone

Background Nonsurgical abortion methods have the potential to improve access to high-quality abortion care. Until recently, availability and utilization of mifepristone medical abortion in low-resource countries were restricted due to the limited availability and perceived high cost of mifepristone, leading some providers and policymakers to support use of misoprostol-only regimens. Yet, this may not be desirable if misoprostol-only regimens are considerably less effective and ultimately more costly for health care systems. This study sought to document the differences in efficacy between two nonsurgical abortion regimens. Study Design This double-blind randomized placebo-controlled trial enrolled women with gestational ages up to 63 days seeking early medical abortion from August 2007 to March 2008 at a large tertiary hospital in Ho Chi Minh City, Vietnam. Eligible consenting women received either (1) two doses of 800 mcg buccal misoprostol 24 h apart or (2) 200 mg mifepristone and 800 mcg buccal misoprostol 24 h later. Participants self-administered all study drugs and returned to the hospital for follow-up 1 week later. The trial is registered at ClinicalTrials.gov as NCT00680394. Results Four hundred women were randomized to either misoprostol-only (198) or mifepristone+misoprostol (202). Complete abortion occurred for 76.2% ( n=147) of women allocated to misoprostol-only vs. 96.5% ( n=194) of those given mifepristone+misoprostol (RR 0.79, 95% CI 0.73–0.86). Ongoing pregnancy was documented for 16.6% (32) of misoprostol-only users and 1.5% (3) of mifepristone+misoprostol users (1.62, 0.68–3.90). Side effects were generally similar for both groups, although significantly more women allocated to misoprostol-only reported diarrhea. Conclusions Mifepristone+misoprostol is significantly more effective than use of misoprostol-alone for early medical abortion. The number of ongoing pregnancies documented with misoprostol-only warranted an early end of the trial after unblinding of the study at interim analysis. Policymakers should advocate for greater access to mifepristone. Future research should prioritize misoprostol-only regimens with shorter dosing intervals.

Has mifepristone medical abortion expanded abortion access in New Mexico? A survey of Ob/Gyn and family medicine physicians

To examine the impact of mifepristone medication abortion availability on abortion access in New Mexico, we conducted two surveys of attitudes, barriers and provision of medication abortion among New Mexico Ob/Gyn and family medicine (FM) physicians in the years 2001 and 2008.