Efficacy of medical abortion prior to 6 gestational weeks: a systematic review

Kapp, Nathalie; Baldwin, Maureen K.; Rodríguez, María I.

doi:10.1016/j.contraception.2017.09.006

Cited by 36 publications

(25 citation statements)

References 31 publications

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“…Although 1 limitation of the available evidence was that it was not powered to detect any between‐group differences in “missed diagnosis of ectopic pregnancy” and “ongoing pregnancy”, the absolute risk of both of these outcomes was very low. Furthermore, the absence of any clinically significant differences in “complete abortion (without the need for [repeat] surgical intervention)” in the available evidence between women with definitive evidence of an intrauterine pregnancy on ultrasound compared with women who had an ultrasound but where an intrauterine pregnancy could not be confirmed is encouraging, and concurs with other reviews . So long as it is safe and effective, women are likely to value being able to proceed with abortion without delay, as demonstrated in other evidence showing that women have clear preferences not to prolong waiting times .…”

Section: Discussionsupporting

confidence: 72%

“…Furthermore, the absence of any clinically significant differences in "complete abortion (without the need for [repeat] surgical intervention)" in the available evidence between women with definitive evidence of an intrauterine pregnancy on ultrasound compared with women who had an ultrasound but where an intrauterine pregnancy could not be confirmed is encouraging, and concurs with other reviews. 15 So long as it is safe and effective, women are likely to value being able to proceed with abortion without delay, as demonstrated in other evidence showing that women have clear preferences not to prolong waiting times. 10 However, the main concern about initiating abortion before an intrauterine pregnancy can be confirmed is to miss an ectopic pregnancy and it is therefore necessary to fully assess the risk of an ectopic pregnancy before initiation of such an abortion.…”

Section: Discussionmentioning

confidence: 99%

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Initiation of abortion before there is definitive ultrasound evidence of intrauterine pregnancy: A systematic review with meta‐analyses

Schmidt‐Hansen

Cameron

Lord

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Women are increasingly presenting for abortion at very early gestation. However, providers may be reluctant to conduct abortion at this stage as they may be concerned that they cannot exclude an ectopic pregnancy or that they may terminate a non‐viable pregnancy, or may be concerned that both medical and surgical methods may be less effective at this stage of gestation. This provider concern may result in delays in the abortion as additional investigations may be required until an intrauterine pregnancy can be confirmed. Additional unnecessary visits may be distressing for women and waste health service resources. The objective of this systematic review was to determine whether it is safe and effective to initiate abortion before there is ultrasound evidence of an intrauterine pregnancy. Material and methods We searched Embase Classic, Embase; Ovid MEDLINE® Epub Ahead‐of‐Print, In‐Process & Other Non‐Indexed Citations, Ovid MEDLINE® Daily, Ovid MEDLINE®; and Cochrane Library on 25 October 2019. Eligible studies were randomized and non‐randomized comparative studies, published in English from 1985, comparing initiation of abortion before there is definitive evidence of an intrauterine pregnancy with initiation afterwards. We assessed risk‐of‐bias using the Newcastle‐Ottowa scale. All outcomes were analyzed as risk ratios (RR) and meta‐analyzed using the Mantel‐Haenszel method. The quality of the evidence was assessed using GRADE. Results Two non‐randomized studies (n = 3785) showed no differences in “missed ectopic pregnancy” (RR = 0.26, 95% CI 0.03‐2.12), “ongoing pregnancy” (RR = 1.06, 95% CI 0.34‐3.34), or “complete abortion without surgical intervention” (RR = 1, 95% CI 0.98‐1.02) between initiation of medical abortion before or after ultrasound evidence of an intrauterine pregnancy. A third non‐randomized study (n = 1530) showed no differences between initiation of surgical abortion before or after ultrasound evidence of an intrauterine pregnancy in “missed ectopic pregnancy” (no events), “ongoing pregnancy” (RR = 0.56, 95% CI 0.03‐11.59) or “complete abortion without repeat surgical intervention” (RR = 1, 95% CI 0.99‐1.01). The quality of evidence was very low. Conclusions Initiation of abortion before there is definitive ultrasound evidence of an intrauterine pregnancy in women without signs or symptoms of an ectopic pregnancy should be considered.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Initiation of abortion before there is definitive ultrasound evidence of intrauterine pregnancy: A systematic review with meta‐analyses

Schmidt‐Hansen

Cameron

Lord

et al. 2020

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

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“…Another situation is the use of uterine curettage as a method for emptying the uterus, even among those who had previously used misoprostol, something that goes against studies on the medication's effectiveness 56,57 , as well as against World Health Organization recommendations 58 . The high frequency of curettage in Latin America had been found in a study of medication provision through telemedicine in the entire world 59 .…”

Section: Discussionmentioning

confidence: 99%

Aborto legal no Brasil: revisão sistemática da produção científica, 2008-2018

et al. 2020

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Resumo: Revisões anteriores sobre o aborto no Brasil estimaram um milhão de procedimentos anuais, porém, não abordaram o aborto legal. O objetivo desta revisão sistemática foi atualizar o conhecimento sobre o aborto legal, quanto ao perfil dos serviços, das mulheres atendidas, conhecimento de estudantes e médicos, situação de anencefalia e malformações graves. A busca de artigos foi via MEDLINE e LILACS, de 2008 a 2018, sem restrição de idiomas. A qualidade dos artigos foi avaliada com instrumentos do Joanna Briggs Institute. Busca, seleção, avaliação de qualidade e extração de dados foram feitas independentemente por duas pesquisadoras. Selecionaram-se 20 artigos, 11 sobre conhecimento e opinião de profissionais médicos (4 artigos) e estudantes de Medicina (7 artigos), revelando conhecimento aquém do ideal sobre o aborto legal e objeção de consciência elevada. Seis estudos sobre as mulheres atendidas identificaram que elas são jovens, solteiras e a principal demanda foi a gravidez decorrente de estupro. A demora em procurar atendimento ocorreu dentre as mais jovens, solteiras e quando o agressor era alguém próximo. Três estudos sobre malformações graves mostraram autorização judicial em torno de 40%. Nos casos sem autorização, a evolução da gravidez foi complicada e o parto foi cesáreo. Apenas um artigo abordou os serviços de aborto legal, apontando 37 dos 68 cadastrados em atividade, inexistência em sete estados e concentração nas capitais. O conhecimento sobre o aborto legal ainda é escasso, a demanda do procedimento é reprimida e a formação médica é deficiente no tema.

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“…Moreover, as shown in the systematic review undertaken by Kapp et al for this Special Edition existing research "supports the use of medical abortion at gestational ages b42 days". [7] Efficacy rates were found to be high overall and appeared to reflect rates observed during the 7th week of pregnancy. In short, women can initiate MA use as soon as they suspect or discover they are pregnant.…”

mentioning

confidence: 93%