Supporting Maternal Autonomy in Medical Abortion Pathways

From the woman's perspective, the clinical safety of medical abortion using a recommended regimen is well-established. There is, however, considerable debate about options for women who change their mind wishing to discontinue a medical abortion and continue their pregnancy instead. Mifepristone antagonization with progesterone, known colloquially as "abortion reversal", has been proposed by some and opposed by others in political, clinical, and scientific arenas. Current literature and clinical guidelines recommend against providing active measures for women who change their mind after commencing medical abortion, citing pharmacological implausibility of the progesterone-after-mifepristone approach, and lack of quality evidence from well-designed clinical trials in this area. For women in such a situation who choose to then try and keep their pregnancy, adherence to the four pillars of medicine, namely autonomy, justice, beneficence and non-maleficence, favours treatment of these women with progesterone. This chapter critically analyses key areas relevant to the intervention of mifepristone antagonism by progesterone, including demand, pharmacological basis, clinical evidence, safety for the woman, patient autonomy, and clinician duty of care. Other important issues requiring consideration include: evidence for untreated pregnancy continuation rates after mifepristone, success rates relating to gestational age, and the actual number of women discontinuing medication abortion and seeking to keep their pregnancy.