New Zealand College of Sexual & Reproductive Health

Abortion Training

Module 2: Early Medical Abortion

8. Further reading and resources

Open access resources are marked with an asterisk (*) at the beginning.

Pharmacology of medicines used for EMA

Frye, L.J., Byrne, M.E., Winikoff, B. (2016). A crossover pharmacokinetic study of misoprostol by the oral, sublingual and buccal routes. The European Journal of Contraception & Reproductive Health Care 21:265-268. Available from:

Bernard, N., Elefant, E., Carlier, P., et al. (2013). Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study. BJOG 120(5):568–74. Available from:

Mark, A., Foster, A.M., Grossman, D., et al. (2019). Foregoing Rh testing and anti-D immunoglobulin for women presenting for early abortion: a recommendation from the National Abortion Federation’s Clinical Policies Committee. Contraception 99(5):265–6. Available from:

* Medsafe. Cytotec Data Sheet. 2019. Available from:

* Medsafe. Mifegyne Data Sheet. 2001. Available from:

Vauzelle, C., Beghin, D., Cournot, M.P., Elefant, E. (2013). Birth defects after exposure to misoprostol in the first trimester of pregnancy: prospective follow-up study. Reproductive toxicology 36:98–103. Available from

* Wiebe, E.R., Campbell, M., Aiken, A.R.A., Albert, A. (2019). Can we safely stop testing for Rh status and immunizing Rh-negative women having early abortions? A comparison of Rh alloimmunization in Canada and the Netherlands. Contracept X. 1:100001. Available from

* A short video explainer (1 min 24 sec) about the action of mifepristone from Advancing New Standards in Reproductive Health (ANSIRH) is available here: ANSIRH is a programme within the University of California San Francisco (UCSF) Bixby Center for Global Reproductive Health and is a part of UCSF’s Department of Obstetrics, Gynecology & Reproductive Sciences.

The EMA procedure

Abbas, D., Chong, E., Raymond, E.G. (2015). Outpatient medical abortion is safe and effective through 70 days gestation. Contraception 92:197–199. Available from

Goldstone, P., Michelson, J., Williamson, E. (2012). Early medical abortion using low-dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust. 197 (5): 282–286. Available from:

Kaneshiro, B., Edelman, A., Sneeringer, R.K., Ponce De Leon, R.G. (2011). Expanding medical abortion: can medical abortion be effectively provided without the routine use of ultrasound? Contraception 83:194–201. Available from:

Gambir, K., Kim, C., Necastro, K.A., et al. (2020). Self administered versus provider administered medical abortion. Cochrane Database of Systematic Reviews 3:CD013181.

Raymond, E.G., Shannon, C., Weaver, M.A., Winikoff, B. (2012). First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Contraception 87:26–37. Available from:

Suhonen, S., Tikka, M., Kivinen, S., Kauppila, T. (2011). Pain during medical abortion: predicting factors from gynecologic history and medical staff evaluation of severity. Contraception 83:357–61. Available from:

* von Hertzen, H., Huong, N.T., Piaggio, G., et al. (2010). Misoprostol dose and route after mifepristone for early medical abortion: a randomised controlled noninferiority trial. BJOG 117:1186–1196. Available from:

Zhang, J., Zhou, K., Shan, D., Luo, X. (2022). Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews 5:CD002855.

Follow up care and management of complications

Baiju, N., Acharya, G., D’Antonio, F., Berg, R.C. (2019). Effectiveness, safety and acceptability of self-assessment of the outcome of first-trimester medical abortion: A systematic review and meta-analysis. BJOG 126(13):1536–1544. Available from:

Grossman, D., & Grindlay, K. (2011). Alternatives to ultrasound for follow-up after medication abortion: A systematic review. Contraception 83(6):504–510. Available from:

Kerns , J.L., Brown, K., Nippita, S., Steinauer, J. (2023). Society of Family Planning Clinical Recommendation: Management of hemorrhage at the time of abortion. Contraception. Available online 20 September 2023, 110292. Available from

Pocius KD, Maurer R, Fortin J, Goldberg AB, Bartz D. (2015). Early serum human chorionic gonadotropin (hCG) trends after medication abortion. Contraception 91:503–506. Available from:

Raymond, E. G., Shochet, T., Bracken, H. (2018). Low-sensitivity urine pregnancy testing to assess medical abortion outcome: A systematic review. Contraception 98(1):30–35. Available from:

Schmidt-Hansen, M., Cameron, S., Lohr, P.A., Hasler, E. (2020). Follow-up strategies to confirm the success of medical abortion of pregnancies up to 10 weeks’ gestation: A systematic review with meta-analyses. AJOG 222:551–563.e13. Available from:

Patient support

Aamlid, I.B., Dahl, B., Sommerseth, E. (2021). Women’s experiences with information before medication abortion at home, support during the process and follow-up procedures—A qualitative study. Sexual & Reproductive Healthcare 27:100582. Available from

Mahanaimy, M., Gerdts, C., Moseson, H. (2022). What constitutes a good healthcare experience for unintended pregnancy? A qualitative study among young people in California. Culture, Health & Sexuality 24:330–343. Available from

* Purcell, C., Cameron, S., Lawton, J., et al (2017). Self‐management of first trimester medical termination of pregnancy: A qualitative study of women’s experiences. BJOG 124:2001–2008. Available from:

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