Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial

Abstract

PostprintThis is the accepted version of a paper published in The Lancet. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the original published paper (version of record):Klingberg-Allvin, M., Cleeve, A., Atuhairwe, S., Tumwesigye, N M., Faxelid, E. et al. (2015) Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial.

Effectiveness, safety, and acceptability of first‐trimester medical termination of pregnancy performed by non‐doctor providers: a systematic review

“…Three RCTs, and one prospective cohort study, reported on treatment with combined mifepristone and misoprostol regimens for induced TOP with maximum gestational age of 63–70 days (mean 6.4–7.6 weeks of gestation). One RCT used 600 micrograms of oral misoprostol to treat incomplete miscarriage when uterine size was assessed to be below 12 weeks of gestation (mean 8.8 weeks of gestation) (Table ) . A summary of outcome data is presented in Table S1.…”

“…In our ITT analysis for the outcome of effectiveness, three RCTs provided enough information to be included in the analysis . Even though Klingberg‐Allvin et al .…”

Allocation concealment in randomised controlled trials: are we getting better?: Table 1

“…It is unclear whether the research assistants prepared and opened the envelopes to recruit participants Women were randomised to intervention or standard care (1:1) in blocks of 12, stratified by study site, using a computer random number generator. Sequentially numbered, opaque, sealed envelopes, each containing a random allocation, were prepared at the coordinating centre and later opened in consecutive order by the research assistants after obtaining written consent Klingberg-Allvin et al, 2015 18 88% chance of prediction Participants were randomised (1:1) with a web based system by random permuted blocks with variable block size (range 2-4), stratified by centre Broekhuijsen et al, 2015 19 Use of envelopes is inadequate. It is unclear who opened the envelopes-if recruiting clinician then increased risk of bias.…”

The Imperative to Expand Provision, Access and Use of Misoprostol for Post-Abortion Care in sub-Saharan Africa

“…Furthermore, mid-level providers (MLPs) can safely provide first-line PAC services, including MPAC in outpatient settings, if given appropriate training and sufficient support. A recent Ugandan study showed midwives can offer MPAC equally effectively and safely as physicians 14 . However, findings centered about Kampala, the capital city.…”