Abortion care

A 26-year-old books a telehealth appointment: positive home test, she is six weeks by dates, she does not want to be pregnant, and she wants the tablets. Five years ago this conversation involved a mandatory ultrasound, a certified prescriber, and a wait. Today, in Australia, the mifepristone and misoprostol pack can reach her the next day, and the evidence — the VEMA trial published in the New England Journal of Medicine in 2024 — says she does not even need a confirmatory scan first.^[1][4] This topic is that whole pathway: the regimens, the limits, the analgesia, and the counselling sentences that decide whether care is safe and whether she comes back.

Overview and definition

Induced abortion is the deliberate ending of a pregnancy before viability. Distinguish it from three look-alikes: spontaneous early pregnancy loss (miscarriage), ectopic pregnancy, and emergency contraception — they share bleeding and a positive test, but they are not abortion care.^[1][5]

Abortion care splits first by method, then by gestation. ^[1]

• Medical abortion uses mifepristone plus a prostaglandin (misoprostol) to end the pregnancy pharmacologically; the woman manages most of it at home in the first trimester.^[3][5]
• Surgical abortion removes the pregnancy mechanically: vacuum aspiration (manual or electric) to about 14 weeks, and dilation and evacuation beyond.^[1][16]

The trimester frame matters because the method, the regimen, and the complication rate all change with gestation: first trimester at 12 weeks or earlier, early second trimester at 13 to 20 weeks, late second trimester at 21 weeks and beyond. Complication rates rise with gestational age — an Australian audit of 2164 dilation-and-evacuation procedures found an overall complication rate of 2.17 percent, but it was significantly higher beyond 20 weeks.^[1]

References18ShowHide

1. [1]Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Clinical Guideline for Abortion Care (version 1.4) RANZCOG, Melbourne, 2026.Source
2. [2]Bearak J, Popinchalk A, Ganatra B, et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019 Lancet Glob Health, 2020.PMID 32710833
3. [3]Zhang J, Zhou K, Shan D, et al. Medical methods for first trimester abortion Cochrane Database Syst Rev, 2022.PMID 35608608
4. [4]Brandell K, Jar-Allah T, Reynolds-Wright J, et al. Randomized Trial of Very Early Medication Abortion N Engl J Med, 2024.PMID 39504520
5. [5]Cameron ST Early medical abortion Best Pract Res Clin Obstet Gynaecol, 2025.PMID 40015183
6. [6]White K, Carroll E, Grossman D Complications from first-trimester aspiration abortion: a systematic review of the literature Contraception, 2015.PMID 26238336
7. [7]Wen J, Cai QY, Deng F, et al. Manual versus electric vacuum aspiration for first-trimester abortion: a systematic review BJOG, 2008.PMID 18053098
8. [8]Allen RH, Singh R Society of Family Planning clinical guidelines pain control in surgical abortion part 1 - local anesthesia and minimal sedation Contraception, 2018.PMID 29407363
9. [9]Cansino C, Denny C, Carlisle AS, et al. Society of Family Planning clinical recommendations: Pain control in surgical abortion part 2 - Moderate sedation, deep sedation, and general anesthesia Contraception, 2021.PMID 34425082
10. [10]Reynolds-Wright JJ, Woldetsadik MA, Morroni C, et al. Pain management for medical abortion before 14 weeks' gestation Cochrane Database Syst Rev, 2022.PMID 35553047
11. [11]Jackson E, Kapp N Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review BJOG, 2020.PMID 32162427
12. [12]Cheng T, Kumar N, Laursen L, et al. Society of Family Planning Clinical Recommendation: Prevention of infection after abortion and pregnancy loss Contraception, 2025.PMID 40154660
13. [13]Gemzell-Danielsson K, Cameron S, Bombas T, et al. Rhesus testing and anti-D prophylaxis in RhD-negative women undergoing first-trimester abortion-Systematic Review and Opinion Int J Gynaecol Obstet, 2026.PMID 40728267
14. [14]Patil R, Dethier D, Fleming M, et al. Society of Family Planning Clinical Recommendation: Telemedicine in family planning care part 2 - Abortion Contraception, 2025.PMID 40073954
15. [15]Kim CR, Lavelanet A, Ganatra B; Abortion Care Guideline Development Group Enabling access to quality abortion care: WHO's Abortion Care guideline Lancet Glob Health, 2022.PMID 35303448
16. [16]Tufa TH, Stewart F, Meckstroth K, et al. Cervical preparation for dilation and evacuation at 12 to 24 weeks gestation Cochrane Database Syst Rev, 2025.PMID 40028776
17. [17]Say L, Kulier R, Gülmezoglu M, et al. Medical versus surgical methods for first trimester termination of pregnancy Cochrane Database Syst Rev, 2005.PMID 15674900
18. [18]Saldanha S, Botfield J, Mazza D Recognising and responding to reproductive coercion in general practice: a qualitative study BMJ Sex Reprod Health, 2026.PMID 41052903