Medical Medical<unk> s are those induced by<unk> rtifacient pharmaceuticals. Medical<unk>  became an alternative method of<unk>  with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s. The most common early first-trimester medical<unk>  regimens use mifepristone in combination with misoprostol (or sometimes another prostaglandin analog, gemeprost) up to 10 weeks (70 days) gestational age, methotrexate in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone. This regimen is effective in the second trimester. Medical<unk>  regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation. In very early<unk> s, up to 7 weeks gestation, medical<unk>  using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical<unk>  (vacuum aspiration), especially when clinical practice does not include detailed inspection of aspirated tissue. Early medical<unk>  regimens using mifepristone, followed 24–48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%. If medical<unk>  fails, surgical<unk>  must be used to complete the procedure. Early medical<unk> s account for the majority of<unk> s before 9 weeks gestation in Britain, France, Switzerland, United States, and the Nordic countries. Medical<unk>  regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second-trimester<unk> s in Canada, most of Europe, China and India, in contrast to the United States where 96% of second-trimester<unk> s are performed surgically by dilation and evacuation. A 2020 Cochrane Systematic Review concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical<unk>  results in an effective<unk> . Further research is required to determine if self-administered medical<unk>  is as safe as provider-administered medical<unk> , where a health care professional is present to help manage the medical<unk> . Safely permitting women to self-administer<unk>  medication has the potential to improve access to<unk> . Other research gaps that were identified include how to best support women who choose to take the medication home for a self-administered<unk> . Surgical A vacuum aspiration<unk>  at eight weeks gestational age (six weeks after fertilization).1: Amniotic sac2: Embryo3: Uterine lining4: Speculum5: Vacurette6: Attached to a suction pump Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration are the most common surgical methods of induced<unk> . Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) uses an electric pump. These techniques can both be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later. MVA, also known as "mini-suction" and "menstrual extraction" or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and<unk> . The World Health Organization recommends sharp curettage only when suction aspiration is unavailable. Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.<unk>  may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy<unk>  is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction<unk> . First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia. Labor induction<unk>  In places lacking the necessary medical skill for dilation and extraction, or where preferred by practitioners, an<unk>  can be induced by first inducing labor and then inducing fetal demise if necessary. This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced<unk> s throughout the second trimester are labor-induced<unk> s in Sweden and other nearby countries. Only limited data are available comparing this method with dilation and extraction. Unlike D&E, labor-induced<unk> s after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced<unk>  is legally risky in the United States. Other methods Historically, a number of herbs reputed to possess<unk> rtifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium. In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil. Because the indiscriminant use of herbs as<unk> rtifacients can cause serious—even lethal—side effects, such as multiple organ failure, such use is not recommended by physicians.<unk>  is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage. In Southeast Asia, there is an ancient tradition of attempting<unk>  through forceful abdominal massage. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an<unk>  upon a woman who has been sent to the underworld. Reported methods of unsafe, self-induced<unk>  include misuse of misoprostol and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical<unk>  is legal and available.
Abortion
Hysterotomy abortion
Instillation abortion
Superfecundation
Postpartum confinement
Hormonal IUDs
Intrauterine device
Natural childbirth