Principles of abortion and miscarriage management

Internists play a crucial role in enhancing access to safe and effective pill-based protocols for medication abortion and miscarriage management. Despite historically limited provision by obstetrician–gynecologists and family medicine physicians, a mere 7% of whom provided abortions in the USA, the landscape is evolving. With only approximately 1500 abortion providers nationwide, many women, particularly those in rural or low-income areas, face significant hurdles in accessing care.

General internists, numbering nearly 100,000 across the USA, are uniquely positioned to bridge this accessibility gap. The adoption of medication abortion protocols, pioneered in France in 1982 with mifepristone (RU-486), offers a promising avenue. Mifepristone, an anti-progestin, combined with misoprostol, has demonstrated high efficacy for inducing abortion or managing miscarriage. While medication abortion rates have risen gradually, the majority still occur in specialized abortion clinics rather than primary care settings. The process of providing mifepristone and misoprostol aligns closely for both abortion and miscarriage management. Key steps involve gestational age assessment, which can often be determined via history alone. Ultrasound confirmation is necessary for miscarriage diagnosis but not mandatory for abortion provision. Few contraindications exist, with cesarean section history posing no obstacle.

Post-medication administration, follow-up is crucial, typically scheduled within 5–14 days. This follow-up, facilitated in-person, via telephone, or electronically, ensures patient safety and provides an opportunity for symptom assessment and complication screening. By integrating mifepristone and misoprostol provision into primary care practices, physicians can mitigate barriers to reproductive healthcare. This approach aligns with recent evidence supporting safe, effective medication management in primary care settings, offering patients timely access and reducing stigma.