Supporting Maternal Autonomy in Medical Abortion Pathways

From the woman’sWomen perspective, the clinical safetySafety of medical abortionMedical abortion using a recommended regimen is well-established. There is, however, considerable debate about options for womenWomen who change their mind wishing to discontinue a medical abortionMedical abortion and continue their pregnancyPregnancy instead. MifepristoneMifepristone antagonization with progesterone, known colloquially as “abortion reversalAbortion reversal”, has been proposed by some and opposed by others in political, clinical, and scientific arenas. Current literature and clinical guidelinesGuidelines recommend against providing active measures for womenWomen who change their mind after commencing medical abortionMedical abortion, citing pharmacological implausibility of the progesterone-after-mifepristoneMifepristone approach, and lack of quality evidenceEvidence from well-designed clinical trialsClinical trials in this area. For womenWomen in such a situation who choose to then try and keep their pregnancyPregnancy, adherence to the four pillars of medicine, namely autonomyAutonomy, justice, beneficence and non-maleficence, favours treatment of these womenWomen with progesterone. This chapter critically analysesAnalysis key areas relevant to the interventionIntervention of mifepristoneMifepristone antagonism by progesterone, including demand, pharmacological basis, clinical evidenceEvidence, safetySafety for the womanWomen, patient autonomyAutonomy, and clinician duty of careDuty of care. Other important issues requiring consideration include: evidenceEvidence for untreated pregnancyPregnancy continuation rates after mifepristoneMifepristone, success rates relating to gestational age, and the actual number of womenWomen discontinuing medication abortionAbortion and seeking to keep their pregnancyPregnancy.