Practice bulletin no. 143: medical management of first-trimester abortion

Obstet Gynecol. 2014 Mar;123(3):676-692. doi: 10.1097/01.AOG.0000444454.67279.7d.


Over the past three decades, medical methods of abortion have been developed throughout the world and are now a standard method of providing abortion care in the United States. Medical abortion, which involves the use of medications rather than a surgical procedure to induce an abortion, is an option for women who wish to terminate a first-trimester pregnancy. Although the method is most commonly used up to 63 days of gestation (calculated from the first day of the last menstrual period), the treatment also is effective after 63 days of gestation. The Centers for Disease Control and Prevention estimates that 64% of abortions are performed before 63 days of gestation (1). Medical abortions currently comprise 16.5% of all abortions in the United States and 25.2% of all abortions at or before 9 weeks of gestation (1). Mifepristone, combined with misoprostol, is the most commonly used medical abortion regimen in the United States and Western Europe; however, in parts of the world, mifepristone remains unavailable. This document presents evidence of the effectiveness, benefits, and risks of first-trimester medical abortion and provides a framework for counseling women who are considering medical abortion.

Publication types

  • Practice Guideline

MeSH terms

  • Abortifacient Agents* / adverse effects
  • Abortion, Induced / methods*
  • Administration, Intravaginal
  • Administration, Oral
  • Clinical Protocols
  • Directive Counseling
  • Drug Administration Schedule
  • Female
  • Humans
  • Methotrexate / adverse effects
  • Mifepristone* / adverse effects
  • Misoprostol* / adverse effects
  • Patient Selection
  • Pregnancy
  • Pregnancy Trimester, First*
  • Tamoxifen / adverse effects


  • Abortifacient Agents
  • Tamoxifen
  • Misoprostol
  • Mifepristone
  • Methotrexate