The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of "Major Recommendations" field.
The following recommendations are based primarily on good and consistent scientific evidence (Level A):
- Medical abortion should be considered a medically acceptable alternative to surgical abortion in selected, carefully counseled, and informed women.
- The U.S. Food and Drug Administration (FDA)-approved protocol of 600 milligrams of mifepristone orally followed approximately 48 hours later by 400 micrograms of misoprostol orally is safe and effective for medical abortion through 49 days of gestation (calculated from the first day of the last menstrual period [LMP]).
- Compared with the FDA-approved regimen, mifepristone-misoprostol regimens using 200 milligrams of mifepristone orally and 800 micrograms of misoprostol vaginally are associated with a decreased rate of continuing pregnancies, decreased time to expulsion, fewer side effects, improved complete abortion rates, and lower cost for women with pregnancies up to 63 days of gestation based on last menstrual period.
- A methotrexate-misoprostol regimen is appropriate for medical abortion only in pregnancies up to 49 days of gestation. Women using this regimen may wait up to 4 weeks for complete abortion to occur.
- Mifepristone-misoprostol regimens using 200 milligrams of mifepristone orally and 800 micrograms of misoprostol vaginally are generally preferred to regimens using methotrexate and misoprostol or misoprostol only for medical abortion.
- A patient can administer misoprostol safely and effectively, orally or vaginally, in her home as part of a medical abortion regimen.
The following recommendations are based primarily on limited scientific evidence (Level B):
- Because teratogenicity of medical abortifacients becomes an important issue if the pregnancy continues, patients must be informed of the need for a surgical abortion in the event of a failed abortion.
- Gestational age should be confirmed by clinical evaluation or ultrasonography
The following recommendations are based primarily on consensus and expert opinion (Level C):
- Surgical curettage must be available on a 24-hour basis for cases of hemorrhage, even though less than 1% of women having a medical abortion will need a curettage because of excessive bleeding.
- Pretreatment anti-D immune globulin should be administered if indicated.
- No data exist to support the universal use of prophylactic antibiotics for medical abortion.
Definitions:
Grades of Evidence
I Evidence obtained from at least one properly designed randomized controlled trial
II-1 Evidence obtained from well-designed controlled trials without randomization
II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Levels of Recommendation
Level A - Recommendations are based on good and consistent scientific evidence.
Level B - Recommendations are based on limited or inconsistent scientific evidence.
Level C - Recommendations are based primarily on consensus and expert opinion.
