Can misoprostol and mifepristone be used for medical management of abortion after the first trimester?

Summary: While misoprostol in combination with mifepristone is most commonly used by clinicians in the United States to end an early pregnancy (<10 weeks of gestation), it may be used later in gestation as well. In the United States, surgical methods are more commonly used after the first trimester. The medications used for abortions after the first trimester are often the same as those used in early pregnancy, though the dosages differ depending on gestational age. In the United States and Western Europe, mifepristone and misoprostol are the most commonly used medications. Mifepristone acts on the endometrium to block the action of progesterone, which is required to maintain pregnancy. Misoprostol causes cervical softening and uterine contractions that open the cervix and expel the contents of the uterus, including the pregnancy and the placenta. The safety of these procedures has recently been summarized in a report from the National Academies of Sciences, Engineering, and Medicine (NASEM). Many organizations, including the World Health Organization (WHO), the National Abortion Federation (NAF), the Society of Family Planning (SFP), the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and Gynuity Health Projects8 (Gynuity) have published clinical instructions for medical management of abortion in pregnancies at later gestational ages using misoprostol in combination with mifepristone (if available), from 12 weeks or later (referred to as later medication abortion in this fact sheet).* Outside of the clinical setting, the use of mifepristone and misoprostol for inducing abortion up to 24 weeks has also been documented in Indonesia and Argentina.