(NEW YORK) — An imminent ruling from a Texas federal judge could soon block the use of a common abortion medication across the United States, leaving one drug available.

More than half of all abortions in the United States use a combination of two drugs, mifepristone and misoprostol, according to the Guttmacher Institute, a research group focusing on sexual and reproductive health.

However, a lawsuit is asking that mifepristone be pulled from the market just months after the Supreme Court overturned Roe v. Wade.

The lawsuit claims mifepristone is not safe, and the U.S. Food and Drug Administration didn’t study it closely enough before it was approved.

Misoprostol would still be available for both abortions and miscarriages on its own, but as an off-label use.

OB-GYNs and abortion providers tell ABC News that data from around the world shows misoprostol is safe and effective — and that they’re ready to provide misoprostol-only abortions — but that the two-dose regimen is more effective.

“We’ve got over 20 years of data showing the safety and efficacy of mifepristone and misoprostol for abortions,” Dr. Alisa Goldberg, an associate professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, told ABC News. “And we know from at least 20 years of data that this regimen works better than misoprostol alone, but if that’s all we have, it’s a safe and reasonable option for patients as well.”

Mifepristone and misoprostol together

Typically, to either induce an abortion or help manage an early miscarriage, mifepristone is taken first. It’s been approved by the FDA since 2000.

Mifepristone works by blocking a hormone called progesterone, which is needed for a pregnancy to continue. This causes the uterine lining to stop thickening and to break down, detaching the embryo.

“It just gets the body primed and ready for the rest of the abortion and then the next step is you take misoprostol,” Dr. Laura Laursen, an OB-GYN at Rush University Medical Center in Chicago, told ABC News.

The second drug, misoprostol, taken 24 to 48 hours later, causes the uterus to contract and dilates the cervix, which will expel the embryo.

When used in combination, the two drugs are nearly 97% effective at terminating a pregnancy, according to a 2015 systematic review from the University of California, Davis.

Is misoprostol effective and what are the side effects?

Currently, the only FDA label use of misoprostol is for gastric ulcers. However, there are several off-label uses for obstetrical and gynecological purposes including treating postpartum hemorrhaging and softening and opening the cervix for patients ready to give birth vaginally, experts told ABC News.

Numerous countries don’t have access to mifepristone and, therefore, only use misoprostol for abortions.

One 2019 study found “misoprostol alone is effective and safe and is a reasonable option for women seeking abortion in the first trimester.”

Another systematic review conducted in July 2020 found misoprostol, especially given in higher doses, was safe and effective in terminating a pregnancy.

However, research suggests that using misoprostol with mifepristone is more effective than misoprostol alone.

“The issue with misoprostol is that it generally takes longer to complete the abortion,” said Laursen. “It’s generally at least three to four doses of misoprostol, three hours apart. So, you know, at least 12 to 18 hours.”

She continued, “There’s more side effects. There is generally more nausea, more diarrhea associated with it.”

How abortion care could change

If mifepristone loses FDA approval, clinicians who provide abortions will be able to offer either surgical abortions or misoprostol-only abortions, but the new regimen will include extra training to properly communicate to patients their options.

“For many of us, it’s going to be the first time we’re prescribing this regimen, many of us didn’t provide abortions before mifepristone was available,” Laursen said. “For us who are experts in dealing with abortion care, we are going to be working through a new system and a new dosing regimen and something that we’re all a little less comfortable with.”

Jennifer Welch, president and CEO of Planned Parenthood of Illinois, said clinics in the state will be ready to provide misoprostol-only abortions.

Illinois clinics have seen an influx of patients travel for abortion care because every state it borders has significantly limited abortion care since the Dobbs v. Jackson Women’s Health Supreme Court decision that saw Roe overturned, according to the Guttmacher Institute.

Mifepristone being banned means patients may lose access to telehealth services to get abortion pills and clinics could be even more inundated.

“The Dobbs decision already made abortion out of access fir many patients who live in states that have banned or so heavily restricted abortion,” Welch said. “And we anticipate that [banning mifepristone] will just make it more difficult for some patients to get the care that they want and need.”

Goldberg said even if people have to rely on misoprostol-only abortions, it’s another step towards stripping Americans of certain reproductive freedoms.

“We know from misoprostol-only abortions that are that are offered around the world that it is a safe and effective option,” she said. “But we also know that mifepristone-misoprostol is better and it’s a shame if we lose it.”

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(TACOMA, Wash.) — Health officials in Washington state said they are set to arrest a woman Friday after they said she has been avoiding treatment or isolation for tuberculosis for over a year.

The Tacoma-Pierce Health Department said the unidentified woman hasn’t complied with several court orders filed since January 2022.

Judge Philip Sorenson issued a civil arrest warrant on Feb. 24 after he found the patient was in civil contempt for refusing to comply with his order that she either resume taking her medication or voluntarily isolate herself, according to the health department.

The patient has until March 3 to comply with the order or she will be taken to a specially designated facility at the Pierce County Jail for isolation, testing and treatment, the health department said.

“In each case like this, we are constantly balancing risk to the public and the civil liberties of the patient. We are always hopeful a patient will choose to comply voluntarily. Seeking to enforce a court order through a civil arrest warrant is always our last resort,” Nigel Turner, a spokesman for the Tacoma-Pierce County Health Department said in a statement.

Attorney information for the infected patient wasn’t immediately available.

TB is caused by a bacterium that can attack vital organs, usually the lungs, and lead to fever, severe cough and possibly death, according to the U.S. Centers for Disease Control and Prevention. The disease can spread when an infected person coughs or speaks and TB bacteria gets into the air, the CDC said. Healthy individuals may then breathe in these bacteria and become infected, according to the CDC.

Although the disease is curable with medication, treatment can take anywhere from three to nine months, according to the CDC.

The Tacoma-Pierce Health Department has legal authority to seek court orders to persuade TB patients to take treatments and isolate according to Washington state law. Turner said this is the third time in 20 years that the health department has had to seek a court order to detain a TB infected patient who refused treatment.

Turner said that health officials worked with the infected patient’s family to persuade her to comply with the health orders.

The woman was under an involuntary isolation order from Dec. 25, 2022, to Feb. 8, according to the health department. Health officials said the woman started treatment but she left before it was complete.

There are roughly 10 million TB cases reported annually around the world, according to the health department. Tacoma averages about 20 cases annually, the health department said.

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