Medical termination of pregnancy

N Engl J Med. 2000 Mar 30;342(13):946-56. doi: 10.1056/NEJM200003303421307.


PIP: This review focuses on advances in the medical termination of pregnancy during the early period of the first trimester, when most abortions are performed. The drugs are used to terminate pregnancy act by inhibiting the synthesis of progesterone, inducing myometrial contractions, antagonizing the action of progesterone, or inhibiting trophoblast development. Among the drugs used in medical abortion are epostane, prostaglandins (including misoprostol and gameprost), combined methotrexate and misoprostol, tamoxifen-misoprostol regimen, mifepristone and prostaglandin, and antiprogestin and prostaglandins. The efficacy, side effects, and contraindications of these drugs in the medical termination of pregnancy are discussed. In general, medical abortion is associated with higher rates of prolonged bleeding, nausea, vomiting, and pain as compared to surgical abortion. However, medical termination of pregnancy has a high rate of efficacy in women with early pregnancies. In addition, medical abortion is safe and acceptable to women, and it does not require anesthesia. Lastly, women who choose medical abortion must have access to a center where suction curettage is available, should heavy bleeding occur and blood transfusion is required.

Publication types

  • Review

MeSH terms

  • Abortifacient Agents* / adverse effects
  • Abortifacient Agents* / pharmacology
  • Abortion, Induced / adverse effects
  • Abortion, Induced / methods*
  • Alprostadil / adverse effects
  • Alprostadil / analogs & derivatives
  • Contraindications
  • Drug Combinations
  • Female
  • Humans
  • Methotrexate / adverse effects
  • Mifepristone / adverse effects
  • Pregnancy / physiology
  • Progesterone / antagonists & inhibitors
  • Prostaglandins / adverse effects
  • Uterine Contraction


  • Abortifacient Agents
  • Drug Combinations
  • Prostaglandins
  • Mifepristone
  • gemeprost
  • Progesterone
  • Alprostadil
  • Methotrexate