Maternal Abortifacient use for Clandestine Abortion

Abortion is a highly debated topic. In the United States and other developed countries, the vast majority of abortions performed are done in a clinical setting or under the supervision of clinical staff. However, clandestine abortions still occur. Previously published reports have described clandestine abortions performed using crude and often dangerous methods. In the United States, published reports on the clandestine use of medications for abortions is rare. We report a series of cases in which maternal use of misoprostol and or a combination of misoprostol and mifepristone was used or suspected to have been used for the purpose of at-home pregnancy termination. These medications, purchased from Internet sites, were believed to have been shipped from countries outside of the United States. With ready accessibility to and increased prevalence of these sites on the Internet, it is likely that maternal abortifacient use will become more common in the future. This paper will provide guidance for the investigation and workup of these cases that come to the attention of the medical examiner or coroner.