A family physician is often the first person with whom a woman discusses her pregnancy. The family physician plays a significant role in confirming the pregnancy and discussing her options. In the past two decades, various combinations of medications that induce abortion have been studied. 2 Mifepristone has recently been approved for this indication by the U.S. Food and Drug Administration, although it may be some time before the drug becomes available on the U.S. market. Regimens using intramuscular methotrexate and vaginal misoprostol have been used successfully in the United States 3-5 and represent a new option for pregnancy termination available to clinicians.
Most women come for pregnancy confirmation very soon after they have missed a menstrual period.
The termination of unwanted pregnancies has historically been a concern of women and health care providers. In current practice, the agents used in medical abortion are methotrexate, misoprostol and mifepristone. It is believed that damage to the trophoblast loosens its connection to the endometrium and decreases trophoblast production of human chorionic gonadotropin. Recognition of these toxic effects led to cures of choriocarcinoma using very high doses of methotrexate. In the 1980s, methotrexate was used in the treatment of ectopic pregnancy, where it was effective and well tolerated.