New Resources and Articles
from Gynuity
New Internet-accessible Features on Mifepristone
In case you missed it, check out this 15 minute video by Angela M. Hill and Karen Rodriguez on the history of mifepristone policy in the U.S. featuring Gynuity president Beverly Winikoff. The video investigates baseless FDA restrictions as well as claims that overstate the danger of the drug. It’s a great refresher on the many barriers to medical abortion access and the burden this puts onto abortion-seekers and care providers.  
Beverly was also featured in an episode of the podcast series Self Managed: An Abortion Story that interviews diverse perspectives on self managed abortion. In the episode, Part 3: The Abortion Pill, RU486, she outlines its invention, introduction to the American market and how the pill expanded globally. Mifepristone has made an enormous impact in allowing women to manage their reproductive lives. Additionally, around the world, there was, and continues to be, a huge need for safe abortion in contexts with deficient health services. Pills have allowed abortion access even where other medical services are lacking. Listen to the full series here.
Expanding outpatient medical abortion with mifepristone and misoprostol through 11 weeks (77 days) of pregnancy
Medical abortion with mifepristone and misoprostol is increasingly used as an outpatient alternative to aspiration, but lack of evidence has limited the use of abortion pills beyond 10 weeks of pregnancy in many clinics and facilities. We sought to bridge the evidence gap about outpatient medical abortion in the later first trimester. Better information about how well a common medical abortion regimen works in the 11th week of pregnancy is beneficial for health providers and for people who prefer to avoid aspiration procedures. An effective medical abortion regimen through 11 weeks also increases access to safe abortion care where providers trained in aspiration are scarce. 

We conducted two sequential studies to evaluate the success of medical abortion regimens in the 11th week of pregnancy.
(1) The first study used a common first trimester outpatient regimen of mifepristone 200mg followed 24-48 hours later by misoprostol 800mcg. Our findings demonstrated a very good chance of success with this regimen, regardless of whether a person was in the 10th week or 11th week of pregnancy. Successful abortion occurred in 92.3% of the 10th week pregnancies (consistent with previously published studies) and in 86.7% of the 11th week pregnancies. The lower success rate in the 11th week was because nearly 9% of pregnancies continued after using the medication regimen. This regimen could be a reasonable option for medical abortion users with 11 week pregnancies, given high success (and safety and acceptability), but the significant increase in continuing pregnancies is concerning. Contraception; Vol. 101(5): 302-308; May 1, 2020.
(2) The second study examined retrospectively relevant data from medical charts of people in the 10th and 11th weeks of pregnancy who had outpatient medical abortions with two doses of misoprostol 800mcg instead of one after the usual mifepristone. 99.6% of people in the 10th week and 97.7% of people in the 11th week who returned for follow up had successful medical abortions. One client (0.4%) in the 10th week and 3 clients (1.4%) in the 11th week had continuing pregnancies. These represent much higher success and lower ongoing pregnancy rates than those observed in the first study with one misoprostol dose. Nevertheless, a high proportion (25%) of clients among the charts that we reviewed did not return to the clinic for follow up, which makes it difficult to draw definitive conclusions about the success of the two-misoprostol-dose regimen since it is possible that those who did not return had continuing pregnancies (or other complications). The bottom line: Mifepristone 200mg followed by 800mcg repeated once after 4 hours is a very promising regimen to improve success over regimens that use mifepristone and a single misoprostol dose in the 10th and 11th weeks. Contraception; Vol. 102(2): 104-108; August 1, 2020.
Multi-level pregnancy test for medical abortion follow-up after 63 days' gestation
We explored hCG patterns using multi-level urine pregnancy tests (MLPTs) among prenatal clients with growing pregnancies to evaluate the potential use of these tests for medical abortion follow-up after 63 days’ gestation. Prenatal clients with gestations 9-12 weeks were asked to administer an MLPT weekly for three weeks. We evaluated change in hCG range over one- and two-week intervals. Despite the fact that these pregnancies were ongoing, a decline in hCG range was observed between weeks 9 and 10 in 43.1% of participants; a decline was observed between weeks 10 and 11 in 26.5%, and between weeks 11 and 12 in 42.1%. The proportion with a decline after two-weeks was 42.0% from weeks 9 to 11 and 48.3% from weeks 10 to 12. We therefore conclude that this follow-up strategy would not work to identify ongoing pregnancies after medical abortion in gestations beyond 63 days. Contraception; Available online 26 May 2020.
Sample protocol for no-test medication abortion
Gynuity and colleagues developed a sample protocol for providing medication abortion to selected patients without any routine facility-based tests either before or after treatment. The sample protocol (now available in Spanish and Russian) was published in Contraception; Vol. 101(6): 361-366; June 1, 2020.