Early medical abortion with self‐administered low‐dose mifepristone in combination with misoprostol

Song, Li-Ping; Tang, Si; Li, Cuilan; Zhou, Lee-Jaden-Gil-Yu-Kang; Mo, Xue-Tang

doi:10.1111/jog.13716

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…Women in selected studies were satisfied both in settings where the option of in‐person abortion care was available and in settings where few alternatives existed. The mean rates of satisfaction were similar to those in studies on medical abortion provided in‐person, of which several also show a preference for self‐administration of misoprostol at home . There were only two studies evaluating acceptability of medical abortion through TM for providers, but they indicated that it is highly acceptable for providers and iis associated with greater flexibility and efficiency …”

Section: Discussionsupporting

confidence: 58%

“…The mean rates of satisfaction were similar to those in studies on medical abortion provided in-person, of which several also show a preference for self-administration of misoprostol at home. [46][47][48] There were only two studies evaluating acceptability of medical abortion through TM for providers, but they indicated that it is highly acceptable for providers and iis associated with greater flexibility and efficiency. 40,41 Abortion through TM may at the least be a highly autonomous option and at most a life-saving alternative for women seeking abortion.…”

Section: Discussionmentioning

confidence: 99%

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Telemedicine for medical abortion: a systematic review

Endler

Lavelanet

Cleeve

et al. 2019

BJOG

175

179

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Background Telemedicine is increasingly being used to access abortion services. Objective To assess the success rate, safety, and acceptability for women and providers of medical abortion using telemedicine. Search strategy We searched PubMed, EMBASE, ClinicalTrials.gov, and Web of Science up until 10 November 2017. Study criteria We selected studies where telemedicine was used for comprehensive medical abortion services, i.e. assessment/counselling, treatment, and follow up, reporting on success rate (continuing pregnancy, complete abortion, and surgical evacuation), safety (rate of blood transfusion and hospitalisation) or acceptability (satisfaction, dissatisfaction, and recommendation of the service). Data collection and analysis Quantitative outcomes were summarised as a range of median rates. Qualitative data were summarised in a narrative synthesis. Main results Rates relevant to success rate, safety, and acceptability outcomes for women ≤10+0 weeks’ gestation (GW) ranged from 0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to 19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8% for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% for dissatisfaction, and 90 to 98% for recommendation of the service. Rates in studies also including women >10+0 GW ranged from 1.3 to 2.3% for continuing pregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% for satisfaction. Qualitative studies on acceptability showed no negative impacts for women or providers. Conclusion Based on a synthesis of mainly self‐reported data, medical abortion through telemedicine seems to be highly acceptable to women and providers, success rate and safety outcomes are similar to those reported in literature for in‐person abortion care, and surgical evacuation rates are higher. Tweetable abstract A systematic review of medical abortion through telemedicine shows outcome rates similar to in‐person care.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Telemedicine for medical abortion: a systematic review

Endler

Lavelanet

Cleeve

et al. 2019

BJOG

175

179

View full text Add to dashboard Cite

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“…Three studies were RCTs, and included data from 1452 women. [21][22][23] Sixteen studies were NRSs and included data from 10 124 women. 16 17 24-36 Sixteen studies were conducted in lowto-middle resource settings (Bangladesh, 25 26 India, 28 30 34 Nepal, 22 31 China, 21 23 Vietnam, 32 33 35 Tunisia, 29 35 Nigeria, 36 Albania 27 and Turkey 24 ).…”

Section: Resultsmentioning

confidence: 99%

“…We downgraded the certainty due to high risk of bias. The RCT [21][22][23] were classified as unclear risk of bias (online supplemental table 2). We did not assess publication bias for the success of medical abortion for the RCTs given there are only three studies.…”

Section: Risk Of Biasmentioning

confidence: 99%

Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19

et al. 2020

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BackgroundIncreased access to home-based medical abortion may offer women a convenient, safe and effective abortion method, reduce burdens on healthcare systems and support social distancing during the COVID-19 pandemic. Home-based medical abortion is defined as any abortion where mifepristone, misoprostol or both medications are taken at home.MethodsA systematic review and meta-analysis of randomised controlled trials (RCTs) and non-randomised studies (NRSs) were conducted. We searched databases from inception to 10 July 2019 and 14 June 2020. Successful abortion was the main outcome of interest. Eligible studies were RCTs and NRSs studies with a concurrent comparison group comparing home versus clinic-based medical abortion. Risk ratios (RRs) and their 95% CIs were calculated. Estimates were calculated using a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess risk of bias by outcome and to evaluate the overall quality of the evidence.ResultsWe identified 6277 potentially eligible published studies. Nineteen studies (3 RCTs and 16 NRSs) were included with 11 576 women seeking abortion up to 9 weeks gestation. Neither the RCTs nor the NRS found any difference between home-based and clinic-based administration of medical abortion in having a successful abortion (RR 0.99, 95% CI 0.98 to 1.01, I2=0%; RR 0.99, 95% CI 0.97 to 1.01, I2=52%, respectively). The certainty of the evidence for the 16 NRSs was downgraded from low to very low due to high risk of bias and publication bias. The certainty of the evidence for the three RCTs was downgraded from high to moderate by one level for high risk of bias.ConclusionHome-based medical abortion is effective, safe and acceptable to women. This evidence should be used to expand women’s abortion options and ensure access to abortion for women during COVID-19 and beyond.PROSPERO registration numberCRD42020183171.

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“…According to another study, 200 mg mifepristone was administered oral in combination with 800 mcg/ml subcutaneously or transvaginal. Studies on the metabolism of mifepristone concluded that no signifi cant differences in blood concentrations within 48 h of administration with oral doses ranging from 100 to 800 mg without any infl uence to the safety and effi cacy [49][50][51][52].Induced abortions were performed in pregnancies of less than 49, 50-56, 57-63 days or <9 weeks [53][54].…”

Section: Disadvantagesmentioning

confidence: 99%

Comparative study for efficacy of termination in first trimester pregnancy using Misoprostol and Mifepristone

Panagiotis¹

2018

Arch Community Med Public Health

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Background: The best method for medical abortion depends fundamentally on pregnancy duration and the fi nal result varies on medical stuff's experience. The aim of this study pertained to investigate the effectiveness of medical abortion using misoprostol, mifepristone or the combination of them. Patients and methods: During the period April 2007 to December 2017, 200 women with pregnancy until 49 days after LMP (last menstrual period) underwent medical termination by using 600 mg mifepristone (RU 486) (Mifegyn) Group A1 per os vs 800 mcg misoprostol (Cytotec) A2 and in other 200 pregnant women, duration between 49-63 days was administrated using 600 mg mifepristone followed 48 hours later 800 mcg misoprostol B1 vaginaly vs. only misoprostol B2. All participants were consistent with surgical abortion if deemed necessary and a transvaginal ultrasound was performed to confi rm an intrauterine pregnancy before the medical administration. The indications for the abortion were as following: missed abortion, endometrial death, spontaneous and induced abortions. Results: According to our study, there was not a case needed to undergo surgical abortion. Common side effects like nausea, vomiting, pain and moderate vaginal bleeding were noticed without the need of hospitalization. Bleeding was occurred earlier in Group A1 compared to Group A2. In addition, abortion started about 3.5 hours earlier in Group A1 compared to Group A2. Similarly, time between administration and abortion was 50% shorter in Group A1 compared to Group A2. The duration of bleeding in Group B1 in Group B2 was similar in the two groups. Analgesia was not necessary for any participant, while repeat administration was more than 7 times more frequent in Group B2 compared to Group B1. Conclusion: The combination of mifepristone and misoprostol and the single administration of mifepristone are safe and effective for medical termination of pregnancy in early fi rst trimester.

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Early medical abortion with self‐administered low‐dose mifepristone in combination with misoprostol

Cited by 17 publications

References 26 publications

Telemedicine for medical abortion: a systematic review

Telemedicine for medical abortion: a systematic review

Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19

Comparative study for efficacy of termination in first trimester pregnancy using Misoprostol and Mifepristone

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