Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Efficacy of Misoprostol Alone for First-Trimester Medical Abortion

A Systematic Review

Raymond, Elizabeth G., MD, MPH; Harrison, Margo S., MD, MPH; Weaver, Mark A., PhD

doi: 10.1097/AOG.0000000000003017
Contents: Abortion: Review

OBJECTIVE: To summarize available data on the effectiveness and safety of single-agent misoprostol for medical abortion in the first trimester.

DATA SOURCES: We searched MEDLINE, CABI, Cochrane, EMBASE, LILACS, the Web of Science, and for English-language studies that evaluated misoprostol alone for abortion of a viable pregnancy in the first trimester.

METHODS OF STUDY SELECTION: Our search yielded 1,562 citations, of which 38 included data from 53 trial groups that met our inclusion and exclusion criteria.

TABULATION, INTEGRATION, AND RESULTS: We abstracted data about each trial group, including study characteristics, treatment regimen, clinical protocol, number of women treated and followed, and numbers with outcomes of interest. We used meta-analytic methods and logistic regression to examine factors associated with surgical intervention after treatment. Among all 12,829 evaluable women, 2,536 (meta-analytic estimate 22.0%, 95% CI 18.8–25.5%) had surgical uterine evacuation. Multiple factors were significantly associated with this proportion, including misoprostol amount per dose and route of administration, loss to follow-up rate, publication date, geographic region, number of misoprostol doses, duration of dosing, and time between dosing and evaluation. Of 6,359 evaluable women, 384 (meta-analytic estimate 6.8%, 95% CI 5.3–8.5%) had ongoing pregnancies. At most 26 of 12,184 evaluable women (meta-analytic estimate 0.7%, 95% CI 0.4–1.0%) were transfused or hospitalized for abortion-related reasons. In trials that provided satisfaction data, most women were satisfied or very satisfied with the treatment (meta-analytic estimate 78%, 95% CI 71–85%).

CONCLUSIONS: Misoprostol alone is effective and safe and is a reasonable option for women seeking abortion in the first trimester. Research is indicated to further refine the regimen and to establish efficacy in the late first trimester.


Treatment regimens that contain only misoprostol can be effective and safe for first-trimester medical abortion.

Gynuity Health Projects, New York, New York; the University of Colorado Hospital Anschutz Medical Campus, Aurora, Colorado; and the Department of Mathematics and Statistics, Elon University, Elon, North Carolina.

Corresponding author: Elizabeth G. Raymond MD, MPH, Gynuity Health Projects, 220 East 42nd Street, Suite 710, New York, NY 10017; email:

Supported by the National Institutes of Health through grant WRHR K12; 5K12HD001271-18, by the Doris Duke Charitable Foundation, and by Gynuity Health Projects.

Financial Disclosure Mark A. Weaver has a consulting agreement with Gynuity Health Projects. The other authors did not report any potential conflicts of interest.

The authors thank Kristen Desanto for her help with the comprehensive literature review that was required for this publication.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews are available at

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.