ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Medical management of abortion

Abstract

According to the U.S. Centers for Disease Control and Prevention, 1.18 million legal abortions were performed in the United States in 1997. Of these, 55.5% were performed at or before 56 days of gestation (calculated from the first day of the last menstrual period [LMP]) (I). Almost 98% of abortion procedures were performed by uterine curettage; all but 1% of these used suction curettage. There were 305 legal induced abortions per 1,000 live births, and the abortion rate was 20 per 1,000 women aged 15-44 years. For the first time in 1997, medical abortions were counted and comprised 0.25% of all abortions; 0.45% of those procedures were performed up to 56 days of gestation. Because of the lack of availability of mifepristone, these procedures mostly represent the use of a combination of methotrexate and misoprostol. Over the past two decades, medical methods of abortion have developed throughout the world and are now used clinically in the United States. This document will present evidence of effectiveness, benefits, and risks of medical methods of abortion and provide a framework for the evaluation and counseling of women who are considering such medical methods.