Medical Abortion Regimens Research Articles

Online Medication Abortion Direct-to-Patient Fulfillment Before and After the Dobbs v Jackson Decision

Online pharmacies have emerged as stakeholders in abortion care since the US Food and Drug Administration (FDA) relaxed in-person dispensing requirements in 2020. The role of online pharmacies in dispensing abortion medications following the Dobbs v Jackson Women's Health Organization decision on June 24, 2022, is understudied. To describe medication abortion prescription fulfillment patterns for 1 online pharmacy 1 year before and after the Dobbs v Jackson decision, considering patient, prescriber, and state policy characteristics. This cross-sectional study assesses deidentified medication abortion prescription fulfilment data from 1 online pharmacy. Prescribers sent prescription requests to the online pharmacy, which dispensed abortion medications to patients by mail. The study sample included prescription requests fulfilled by the online pharmacy between June 20, 2021, and June 24, 2023, for patients aged at least 18 years who received the combined medication abortion regimen. Data were analyzed from July 2023 to July 2024. The US Supreme Court Dobbs v Jackson decision on June 24, 2022. Patient and prescriber characteristics are described, including patient age, state to which the prescription was sent, medications prescribed, and prescribing prescriber's clinic care modality (in-person only, hybrid [in-person and virtual], and virtual only). States were grouped according to the Guttmacher Institute classification of policy support for abortion (most or very supportive, somewhat supportive, and somewhat restrictive). Fulfillment trends were disaggregated by prescriber modality and state policy environment; 2 states with similar telehealth but differing coverage policies (Illinois and Colorado) were compared. The dataset included 87 942 observations. Most prescriptions were sent to individuals younger than 30 years (57.1%), with a mean (SD) age of 28.7 (6.4) years. Throughout the study period, the greatest volume of prescription requests came from states with most or very supportive policies and from prescribers at virtual-only platforms. More prescriptions were sent in the year after Dobbs v Jackson (daily mean [SD], 88.5 [47.2] prescriptions in March 2022 vs 201.5 [97.5] prescriptions in March 2023) with fulfillment spikes following the Dobbs v Jackson leak on May 2, 2022, and decision on June 24, 2022. State policy contexts mirrored the overall trends, while prescriber modality trends were unique, with a big spike in fulfillment at 12 weeks after the Dobbs v Jackson decision for hybrid clinics compared with in-person-only clinics and telehealth-only platforms, which saw their largest spikes in mean daily prescription fulfillment the week immediately after Dobbs v Jackson. Illinois and Colorado had similar fulfillment trends, with spikes immediately following the Dobbs v Jackson decision and overall higher fulfillment after Dobbs v Jackson, with a daily mean (SD) of 10.5 (7.0) prescriptions in Illinois and 8.8 (5.7) prescriptions in Colorado in March 2022 versus 26.6 (13.6) prescriptions in Illinois and 16.7 (10.1) prescriptions in Colorado in March 2023. These findings illustrate the increasingly critical role online pharmacies play in direct-to-patient abortion care provision in the US and the strong linkages between virtual-only prescribers and online pharmacies. These findings suggest that barriers to accessing online pharmacies for abortion care should be removed.

24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion: A Randomized Controlled Trial [ID 2683386

INTRODUCTION: We aimed to compare 24- and 12-hour mifepristone to misoprostol intervals for second-trimester medical abortion. METHODS: This was a prospective randomized controlled trial. Women were allocated to receive mifepristone either 24 or 12 hours before misoprostol administration. The primary outcome was time from mifepristone administration to fetal expulsion and from first misoprostol administration to fetal expulsion. RESULTS: Eighty women were enrolled between July 2020 and June 2023, 40 women per group. Baseline characteristics were comparable between groups. Median time from mifepristone to fetal expulsion was 33.0 and 24.5 hours in the 24- and 12-hour interval groups, respectively (P<.001). Median time from first misoprostol dose to fetal expulsion was 9.5 and 12.5 hours in the 24- and 12-hour interval arms, respectively (P=.028). At 12 hours from misoprostol administration, 25 (62.5%) and 18 (45.0%) of women in the 24- and 12-hour arms completed abortion (P=.178). At 24 hours from misoprostol administration, 36 (90.0%) and 30 (75.0%) in the 24- and 12-hour arms had complete abortion (P=.139). Need for additional medical and/or surgical treatment for uterine evacuation were comparable between groups. Pain scores, side effects, and satisfaction levels were similar in both groups. CONCLUSION: A 12-hour mifepristone-to-misoprostol regimen for medical abortion in the second trimester provides an 8.5-hour shorter mifepristone-to-fetal-expulsion rate compared with the 24-hour interval. However, misoprostol-to-fetal-expulsion time is 3 hours longer in the 12-hour interval regimen. Medical regimen success rate, side effects, and satisfaction levels are also similar. These findings can aid in shared decision-making prior to medical abortion in the second trimester.

Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis.

In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age. This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018-2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area-level deprivation. The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post-approval. The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre-approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post-approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.

Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities

BackgroundIn recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider’s knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels.MethodsUsing a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020.ResultsRegistration of abortion medicines—misoprostol or a combination of mifepristone and misoprostol—was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone—countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula—no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option.ConclusionUnderstanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.

A prospective, comparative study of clinical outcomes following clinic-based versus self-use of medical abortion

BackgroundTo determine whether clinical outcomes differ among women accessing a combined medical abortion regimen from a health clinic when compared with those accessing it from a pharmacy.MethodsWe conducted a multicentre,...

Pain management for medical abortion before 14 weeks' gestation.

Pain management for medical abortion before 14 weeks' gestation.

Abortion Safety and Use With Normally Prescribed Mifepristone in Canada

(Abstracted from N Engl J Med 2022;386:57–67) A medical abortion regimen of mifepristone and misoprostol is safe. In the United States, mifepristone is approved for use only with onerous Risk Evaluation and Mitigation Strategy (REMS) restrictions, which include mandatory prescriber certification, observed dispensing of doses by the prescriber or medical facility (excluding pharmacies), and with submission of a prespecified patient consent form.

The experience of pain in real-time during medication abortion

ObjectiveWe aimed to characterize the current pain experience of patients completing an evidence-based mifepristone-misoprostol medication abortion regimen using real-time pain scores. Study DesignWe collected real-time data on pain experienced by 54 women undergoing medication abortion using an evidence-based regimen of 200 mg mifepristone and 800 mcg buccal misoprostol. These women were enrolled in the placebo arm of a study on the effect of pregabalin for pain during medication abortion. All participants were dispensed ibuprofen and oxycodone/acetaminophen for analgesia. We assessed maximum pain experienced by participants on an 11-point numerical rating scale (NRS), duration of pain, and analgesic usage. Data was collected through electronic surveys sent via text message link at 6 specified points over 72 hours. ResultsOf the 54 women randomized to the placebo group, 2 were lost to follow-up. Participants experienced a mean maximum pain score of 5.5 ± 2.2. The mean time to maximum pain was 3.7 ± 2.4 hours after misoprostol. By hour 12 after misoprostol, 60.8% of participants reported no pain, which increased to 76.9% at 24 hours and 82.0% at 72 hours. Participants reported median ibuprofen usage of 2 800 mg tablets and median oxycodone/acetaminophen usage of one-half of a 5/325mg tablet. Approximately 12.0% of participants reported taking zero ibuprofen tablets, and 50.0% reported no opioid usage during the study period. ConclusionsOur real-time data collection demonstrated lower mean maximum experienced pain scores and shorter duration of pain than previously reported for medication abortion. Analgesic use was lower than previously described. ImplicationsThis updated characterization of pain experienced during an evidence-based medication abortion regimen may allow for better pain-related counseling, tailoring of opioid prescription practices, and improvement in patient satisfaction.

Ohio survey data assessing perceptions of abortion safety

ObjectiveDespite overwhelming data supporting the safety of abortion care in the U.S., public perceptions of abortion safety vary widely. While evidence suggests that the public overestimates abortion risk, few studies have analyzed why people think abortion is safe or unsafe. Study DesignUsing data from the Ohio Survey of Women, a representative survey of women aged 18 to 44 years with a residential address in Ohio, we examined responses to 2 questions about abortion safety perceptions: the first asked respondents to rate abortion safety in Ohio, and the second asked respondents why they chose this rating of abortion safety. We analyzed these responses with inductive and deductive approaches. ResultsThere were 2529 responses, of which 1368 (54%) provided a response to the open-ended question about abortion safety. From this subset, 529 gave open-ended responses indicating that they perceive abortion as safe, with 47% attributing this perception to the procedure being performed by a professional in a regulated environment. In contrast, 370 gave open-ended responses indicating that they perceive abortion as unsafe; the most common explanations referred to health risks (19%) and that safety depends on preexisting health conditions (19%). ConclusionMany participants perceived abortion as safe because it is performed by professionals in a clinical environment or because of personal experiences with abortion. Those perceiving a lack of safety provided more varied responses, including that abortion was dangerous due to a detrimental effect on mental health or protesters at abortion clinics. ImplicationsWe identified that women have a broad range of reasons for perceiving abortion as safe or unsafe. Providers should be aware of this diversity of abortion safety perceptions so that they can best engage with their patients.This updated characterization of pain experienced during an evidence-based medication abortion regimen may allow for better pain-related counseling, tailoring of opioid prescription practices, and improvement in patient satisfaction.

Targeted Smooth Bayesian Causal Forests: An analysis of heterogeneous treatment effects for simultaneous vs. interval medical abortion regimens over gestation

We introduce Targeted Smooth Bayesian Causal Forests (tsBCF), a nonparametric Bayesian approach for estimating heterogeneous treatment effects which vary smoothly over a single covariate in the observational data setting. The tsBCF method induces smoothness by parameterizing terminal tree nodes with smooth functions and allows for separate regularization of treatment effects vs. prognostic effect of control covariates. Smoothing parameters for prognostic and treatment effects can be chosen to reflect prior knowledge or tuned in a data-dependent way. We use tsBCF to analyze a new clinical protocol for early medical abortion. Our aim is to assess the relative effectiveness of simultaneous vs. interval administration of mifepristone and misoprostol over the first nine weeks of gestation. Our analysis yields important clinical insights into how to best counsel patients seeking early medical abortion, where understanding even small differences in relative effectiveness can yield dramatic returns to public health. The model reflects our expectation that the treatment effect varies smoothly over gestation but not necessarily over other covariates. We demonstrate the performance of the tsBCF method on benchmarking experiments. Software for tsBCF is available at https://github.com/jestarling/tsbcf/ and in the Supplementary Material (Starling (2020)).

Two prophylactic pain management regimens for medical abortion ≤63 days' gestation with mifepristone and misoprostol: A multicenter, randomized, placebo-controlled trial

ObjectiveTo determine if either prophylactic tramadol 50 mg or ibuprofen 400 mg/metoclopramide 10 mg result in lower maximal pain compared to placebo in women ≤63 days' gestation having a mifepristone-misoprostol medical abortion. Study designWe conducted a randomized, placebo-controlled trial in Nepal, South Africa, and Vietnam. Participants seeking medical abortion received active treatment or placebo, taken at time of misoprostol and repeated 4 hours later. All had access to additional analgesia. The primary outcome was mean maximum pain score within 8 hours. Participants self-assessed maximum pain using an 11-point numeric rating scale recorded in paper diaries; we analyzed these data using intention-to-treat analysis. Secondary outcomes included use of additional analgesia, side effects, and satisfaction. ResultsWe enrolled 563 patients between June 2016 and October 2017; 5 participants failed to follow up. Mean adjusted maximum pain scores within 8 hours in both active arms were lower than placebo (tramadol: n = 188, 6.78 (95% confidence interval [CI] 6.46, 7.11); ibuprofen/metoclopramide: n = 187, 6.43 (95% CI 6.10, 6.75); placebo: n = 188, 7.42 (95% CI 7.10, 7.74); p = 0.0001). Additional analgesia was used by 97 (52.2%) participants in the tramadol group, 80 (43.0%) in the ibuprofen/metoclopramide group, and 103 (55.7%) in the placebo group, p = 0.04. More dizziness (p = 0.004), headache (p = 0.03), and vomiting (p < 0.001) occurred in the tramadol group. More participants reported experienced pain was the same or less than expected in the ibuprofen/metoclopramide group (p = 0.05); overall abortion satisfaction did not differ by group (p = 0.44). ConclusionsCompared with placebo, tramadol or ibuprofen/metoclopramide co-administered with misoprostol and repeated 4 h later resulted in lower mean maximum pain scores that failed to achieve clinical significance. Women who received ibuprofen/metoclopramide were least likely to use additional analgesia and reported fewer side effects. ImplicationsGiven that tramadol, ibuprofen, and metoclopramide are inexpensive, globally available; and, ibuprofen and metoclopramide are included on the World Health Organization Essential Medicines List, these medicines could be considered for prophylactic pain management during medical abortion.

A Prospective, Comparative Study of Clinical Outcomes Following Clinic-Based Versus Self-Use of Medical Abortion

Background: To determine whether clinical outcomes differ among women accessing a combined medical abortion regimen from a health clinic when compared with those accessing it from a pharmacy. Methods: We conducted a multicenter, prospective, comparative study of women aged ≥15 years seeking medical abortion from 5 clinics and 5 adjacent pharmacy-clusters in 3 provinces of Cambodia. Women were recruited in-person at the point of purchase (clinic or pharmacy). Follow-up for self-reported pill use, acceptability, and clinical outcomes occurred by telephone at day 10 and 30 after mifepristone administration. Findings: Over 10 months, we enrolled 2083 women with 1847 providing outcome data: 937 from clinics and 910 from pharmacies. Most were early in their pregnancy (mean gestational age of 6.3 and 6.1 weeks, respectively) and almost all took the pills correctly (98% and 96%; p=.126). Additional treatment needed to complete the abortion was non-inferior for the pharmacy group (9.3%) compared with the clinic group (12.7%). More women from the clinic group received additional care from a provider, such as antibiotics or diagnostics tests than those from the pharmacy group (11% and 2%; p=0.149), and one ectopic pregnancy (pharmacy group) was successfully treated. Most women said they felt prepared for what happened after taking the pills (91% and 81%, respectively; p=0.055). Interpretation: Self-use of a combined medical abortion product resulted in comparable clinical outcomes as use following a clinical visit. Registration and availability of medical abortion as an over-the-counter product would likely increase women’s access to safe abortion. Clinical Trial Registration Details: Registered with ClinicalTrials.gov (NCT03727308). Funding Information: Funding was provided by Ipas. Declaration of Interests: None to declare. Ethics Approval Statement: This study received ethical approval from the National Ethics Committee for Health Research in Cambodia.

Comparison of the efficacy and safety of two combined misoprostol regimens for second trimester medical abortion

Objective The aim of the study was to compare the efficacy and safety of two combined misoprostol regimens for second trimester medical abortion. Methods This was a retrospective cohort study examining data on singleton pregnancies that underwent second trimester medical abortion between November 2011 and November 2019 in a tertiary care centre in northern Greece. In the first study period (November 2011 to August 2015), the management protocol (protocol 1) consisted of 800 μg vaginal misoprostol followed by 400 μg oral misoprostol, every 3 h, for up to five doses. In the second study period (September 2015 to November 2019), a new protocol (protocol 2) was introduced, where the oral route was changed to sublingual, using the same dosage. The two routes were compared in terms of efficacy and safety. Results The study comprised 85 women: 43 (50.6%) received the protocol 1 regimen (vaginal-oral), while 42 (49.4%) received the protocol 2 regimen (vaginal-sublingual). The groups did not differ in terms of maternal age, gestational age and parity. Sublingual misoprostol was more effective than oral misoprostol, both in terms of dose needed (median 1600 μg vs 2000 μg; p = 0.031) and induction-to-abortion interval (8 h vs 11 h; p = 0.001). Surgical evacuation due to incomplete abortion was necessary in 11.9% of women in the sublingual group vs 18.6% in the oral group (p = 0.394). Women in the sublingual group reported a higher rate of severe pain (odds ratio [OR] 6.061; 95% confidence interval [95% CI] 1.240, 29.619) and shivering (OR 4.632; 95% CI 1.788, 11.995). Conclusion The administration of vaginal-sublingual misoprostol, when compared with the vaginal-oral regimen, was associated with a shorter induction-to-abortion interval but a higher incidence of severe pain and shivering.

Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin Summary, Number 225.

Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications ().

Medication Abortion Up to 70 Days of Gestation

Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications [1].

Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225.

Medication abortion, also referred to as medical abortion, is a safe and effective method of providing abortion. Medication abortion involves the use of medicines rather than uterine aspiration to induce an abortion. The U.S. Food and Drug Administration (FDA)-approved medication abortion regimen includes mifepristone and misoprostol. The purpose of this document is to provide updated evidence-based guidance on the provision of medication abortion up to 70 days (or 10 weeks) of gestation. Information about medication abortion after 70 days of gestation is provided in other ACOG publications ().

A repeat dose of misoprostol 800 mcg following mifepristone for outpatient medical abortion at 64–70 and 71–77 days of gestation: A retrospective chart review

ObjectiveTo compare the effectiveness of outpatient medical abortion with mifepristone 200 mg and two misoprostol 800 mcg doses at 64–70 and 71–77 days of gestation. Study designWe conducted a retrospective chart review of medical abortion outcomes among clients with 64–77 day gestations at a Mexico City public clinic between February 2014 and November 2016 who took mifepristone 200 mg followed 24–48 h later by two doses of misoprostol 800 mcg four hours apart (first dose buccally, second dose sublingually). The primary outcome was successful medical abortion, defined as pregnancy expulsion without surgical intervention. We also assessed additional management and visits to other facilities. We compared outcomes by gestational age (64–70 vs 71–77 days). ResultsOf 602 charts reviewed, we analyzed 232 and 218 in the respective groups for effectiveness; nearly 25% of clients were lost to follow up. Treatment success occurred in 231 (99.6%, 95% CI 97.6–100%) clients at 64–70 days and 213 (97.7%, 95% CI 94.7–99.3%) clients at 71–77 days (p = 0.11). Ongoing pregnancy occurred in 1 (0.4%, 95% CI 0–2.4%) and 3 (1.4%, 95% CI 0.3–4.0%) clients, respectively (p = 0.36). Two charts from the 71–77 days group documented visits to other facilities: one bleeding concern prior to scheduled follow up and a hemorrhage during an aspiration intervention. ConclusionsRegimen effectiveness was high at 64–70 and 71–77 days among clients who attended follow up. However, with 25% attrition, it is difficult to draw definitive conclusions about effectiveness and associated safety. ImplicationsMifepristone 200 mg followed by two doses of misoprostol 800 mcg four hours apart is a promising medical abortion regimen to improve efficacy in pregnancies from 64–77 days of gestation as compared to regimens with an initial single misoprostol dose. Prospective research is recommended to achieve more robust efficacy estimates.

A non-inferiority study of outpatient mifepristone-misoprostol medical abortion at 64–70 days and 71–77 days of gestation

ObjectivesThis open-label non-inferiority study assessed efficacy of a common outpatient medical abortion regimen among people with pregnancies 64–70 days and 71–77 days of gestation. Study designWe defined non-inferiority by a 6% margin of method success. People with intrauterine pregnancies 64–77 days’ gestational age by abdominal ultrasound seeking medical abortion at one of eight clinics and met eligibility criteria were offered participation. Consenting participants took mifepristone 200 mg followed 24–48 h later by misoprostol 800 mcg buccally, and returned after one week for provider evaluation and abdominal ultrasound to determine abortion status. Participants recorded medication use, pregnancy expulsion, daily bleeding and pain scores until the one-week follow up. Clinic staff interviewed participants prior to study discharge to assess acceptability. ResultsSeven hundred and nineteen participants were enrolled, 393 and 326 in the respective groups. Successful expulsion without surgical intervention was achieved in 92.3% of the earlier gestational age group and 86.7% of the later group (difference in proportions 5.6%, 1-sided 95% CI 9.6). Ongoing pregnancy accounted for 3.6% and 8.7% (p = 0.007) of outcomes, respectively. Participants in the 71–77 day group reported nausea and weakness more frequently. Pain, bleeding and acceptability measures between groups were similar. ConclusionAlthough the success rate at 71–77 days of gestation was within the non-inferiority margin, we cannot rule out that it is statistically worse than in the previous gestational week. Significantly more ongoing pregnancies in the later group raise concerns about using the regimen at 71–77 days.

A prospective study of mifepristone and unlimited dosing of sublingual misoprostol for termination of second-trimester pregnancy in Uzbekistan and Ukraine

IntroductionWe aimed to assess the feasibility and acceptability of a second-trimester medical abortion regimen using mifepristone and sublingual misoprostol with no maximum number of misoprostol doses in Uzbekistan and Ukraine.MethodsThis...

Simultaneous Compared With Interval Medical Abortion Regimens Where Home Use Is Restricted: Correction.

Simultaneous Compared With Interval Medical Abortion Regimens Where Home Use Is Restricted: Correction.