brand logo

Am Fam Physician. 2022;106(6):718-719

Clinical Question

Is same-day initiation of medication abortion safe and effective for early pregnancy of unknown location?

Bottom Line

The retrospective cohort study suggests that the same-day start of medication abortion is a reasonable option for more rapid pregnancy termination and exclusion of ectopic pregnancy for patients who had their last menstrual period within 42 days and initial ultrasonography results showing no gestational sac. Patients with major risk factors for or symptoms suggesting ectopic pregnancy were not eligible for same-day medication abortion. A larger randomized controlled trial is necessary to verify the relative effectiveness and safety of same-day initiation of medication abortion vs. delaying it until the diagnosis of intrauterine pregnancy. (Level of Evidence = 2b)


The study is a retrospective cohort of 452 patients with a positive pregnancy test result seeking medication abortion within 42 days of their last menstrual period. Initial ultrasonography showed no gestational sac (intrauterine or ectopic). Those with major risk factors for ectopic pregnancy (e.g., intrauterine device in situ, prior tubal surgery, prior ectopic pregnancy) were not eligible for same-day treatment and were excluded from the study. Of the study cohort, 55 (12%) had initial hCG testing and received same-day start of medication abortion at the discretion of the treating clinician using mifepristone, 200 mg orally, followed by misoprostol, 800 mcg orally within 48 hours, and serial quantitative human chorionic gonadotropin (hCG) testing. The remaining patients had hCG testing and were not treated until intrauterine or ectopic pregnancy was determined (i.e., delay-for-diagnosis group).

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.