Building Bridges: A Case for Community Health Worker Provision of Misoprostol-Only Abortion in the First Trimester

Tebbets, Claire; Santana, Diana; Silvestre, José Ros; Redwine, Dee

doi:10.1089/jwh.2016.6144

Cited by 6 publications

(2 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 46 groups (79% of evaluable women), all women were assessed with ultrasound before the decision of whether to perform surgery, whereas in 6 groups, ultrasound was used only if clinically indicated, and in one group, abortions were provided by community health workers who apparently rarely used ultrasound. 42 The earliest point at which surgical intervention was considered varied from 24 hours to 14 days after the first misoprostol dose. No paper provided explicit criteria for the decision to resort to surgical uterine evacuation, hospitalization or transfusion.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Misoprostol Alone for First-Trimester Medical Abortion

Raymond

Harrison

Weaver

2019

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Objective: To summarize available data on the effectiveness and safety of single-agent misoprostol for medical abortion in the first trimester. Data Sources: We searched Medline, CABI, Cochrane, EMBASE, LILACS, and the Web of Science, and ClinicalTrials.gov for English language studies that evaluated misoprostol alone for abortion of viable pregnancy in the first trimester. Methods of Study Selection: Our search yielded 1562 citations, of which 38 included data from 53 trial groups that met our inclusion and exclusion criteria. Tabulation, Integration, and Results: We abstracted data about each trial group, including study characteristics, treatment regimen, clinical protocol, number of women treated and followed, and numbers with outcomes of interest. We used meta-analytic methods and logistic regression to examine factors associated with surgical intervention after treatment. Among all 12,829 evaluable women, 2536 (meta-analytic estimate 22.0%, 95% CI 18.8%, 25.5%) had surgical uterine evacuation. Multiple factors were significantly associated with this proportion, including misoprostol amount per dose and route of administration, loss to follow-up rate, publication date, geographic region, number of misoprostol doses, duration of dosing, and time between dosing and evaluation. Of 6359 evaluable women, 384 (meta-analytic estimate 6.8%, 95% CI 5.3%, 8.5%) had ongoing pregnancy. At most 26 of 12,184 evaluable women (meta-analytic estimate 0.7%, 95% CI 0.4%, 1.0%)were transfused or hospitalized for abortion-related reasons. In trials that provided satisfaction data, most of women were satisfied or very satisfied with the treatment (meta-analytic estimate 78%, 95% CI 71%, 85%). Conclusions: Misoprostol alone is effective and safe and is a reasonable option for women seeking abortion in the first trimester. Research is indicated to further refine the regimen and to establish efficacy in the late first trimester. Systematic Review Registration: PROSPERO, CRD42018083589.

show abstract

Section: Resultsmentioning

confidence: 99%

Efficacy of Misoprostol Alone for First-Trimester Medical Abortion

Raymond

Harrison

Weaver

2019

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…In rural areas, policymakers could utilize trained CHWs by permitting them to provide counselling and administration of medical abortions to maximize healthcare services. Provision of medical abortion by nurses has been demonstrated to be as safe, acceptable and effective as those by doctors in the same setting [ 22 , 23 ] and this practice has been encouraged by the WHO [ 24 ]. Hence, such services could be utilized to ensure the accessibility of abortion during pandemics.…”

Section: Discussionmentioning

confidence: 99%