The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: a systematic review

Schonberg, Dana; Wang, Lin Fan; Bennett, A. E.; Gold, Marji; Jackson, Emily

doi:10.1016/j.contraception.2014.07.004

Cited by 46 publications

(44 citation statements)

References 32 publications

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“…18 In our sample, 58% of women reported having gestational age confirmed through ultrasonography, and the remainder used a pregnancy calculator based on the date of their last menstrual period, which has been shown to be an accurate method of determining gestational age for early medical abortion. 19 The estimated time for the medications to arrive in the Republic/Northern Ireland is between five and seven days, and 94% of women who used them reported doing so less than a week after they arrived. Thus, while we do not have information on women's exact gestational ages at the time they took the medications, we can estimate that for most women it was less than two weeks after the consultation.…”

Section: Methodsmentioning

confidence: 99%

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Aiken

Digol

Trussell

et al. 2017

BMJ

117

125

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Objectives To assess self reported outcomes and adverse events after self sourced medical abortion through online telemedicine. Design Population based study. Setting Republic of Ireland and Northern Ireland, where abortion is unavailable through the formal healthcare system except in a few restricted circumstances. Population 1000 women who underwent self sourced medical abortion through Women on Web (WoW), an online telemedicine service, between 1 January 2010 and 31 December 2012. Main outcome measures Successful medical abortion: the proportion of women who reported ending their pregnancy without surgical intervention. Rates of adverse events: the proportion who reported treatment for adverse events, including receipt of antibiotics and blood transfusion, and deaths reported by family members, friends, or the authorities. Care seeking for symptoms of potential complications: the frequency with which women reported experiencing symptoms of a potentially serious complication and the proportion who reported seeking medical attention as advised. Results In 2010-12, abortion medications (mifepristone and misoprostol) were sent to 1636 women and follow-up information was obtained for 1158 (71%). Among these, 1023 women confirmed use of the medications, and follow-up information was available for 1000. At the time women requested help from WoW, 781 (78%) were <7 weeks pregnant and 219 (22%) were 7-9 weeks pregnant. Overall, 94.7% (95% confidence interval 93.1% to 96.0%) reported successfully ending their pregnancy without surgical intervention. Seven women (0.7%, 0.3% to 1.5%) reported receiving a blood transfusion, and 26 (2.6%, 1.7% to 3.8%) reported receiving antibiotics (route of administration (IV or oral) could not be determined). No deaths resulting from the intervention were reported by family, friends, the authorities, or the media. Ninety three women (9.3%, 7.6% to 11.3%) reported experiencing any symptom for which they were advised to seek medical advice, and, of these, 87 (95%, 87.8% to 98.2%) sought attention. None of the five women who did not seek medical attention reported experiencing an adverse outcome. Conclusions Self sourced medical abortion using online telemedicine can be highly effective, and outcomes compare favourably with in clinic protocols. Reported rates of adverse events are low. Women are able to self identify the symptoms of potentially serious complications, and most report seeking medical attention when advised. Results have important implications for women worldwide living in areas where access to abortion is restricted.

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Section: Methodsmentioning

confidence: 99%

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Aiken

Digol

Trussell

et al. 2017

BMJ

117

125

View full text Add to dashboard Cite

show abstract

“…According to WHO recommendations, many components of abortion care in the first trimester can be provided on an outpatient basis and by mid‐level providers, and women can self‐administer the abortion medication and self‐assess the abortion completeness at home . Investigating the accuracy of self‐assessment of gestational age (GA) and eligibility for medical abortion, as well as the feasibility of task‐shifting to health workers outside of healthcare facilities are, however, areas requiring further research …”

Section: Introductionmentioning

confidence: 99%

“…9 Investigating the accuracy of self-assessment of gestational age (GA) and eligibility for medical abortion, as well as the feasibility of task-shifting to health workers outside of healthcare facilities are, however, areas requiring further research. [9][10][11][12][13] Telemedicine (TM) is the remote assessment and treatment of patients by means of telecommunications technology, and is an expanding health sector that has the potential to increase access to safe abortion. In the context of abortion care, TM services may be used for counselling and assessment, the acquisition of abortion medication, and clinical guidance through the abortion process.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine for medical abortion: a systematic review

Endler

Lavelanet

Cleeve

et al. 2019

BJOG

174

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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“…Most women can recall their LMP regardless of education or whether or not they routinely record their LMP dates 1, 14, 15. A 2014 systematic review evaluating the accuracy of using LMP alone to assess gestational age before early medical termination included five studies of fair to poor quality, reporting data for more than 7500 women 16. Overall, between 3 and 12% of women eligible for medical termination based on their LMP were actually ineligible when evaluated by ultrasound dating.…”

Section: Resultsmentioning

confidence: 99%

“…In the smaller included studies, this proportion is higher (7–12%). Authors concluded that LMP alone is a promising alternative to determine gestational age, but requires further research if women are to assess eligibility independently 16, 17…”

Section: Resultsmentioning

confidence: 99%

A research agenda for moving early medical pregnancy termination over the counter

Kapp¹,

Grossman

Jackson

et al. 2017

BJOG

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Given the overall safety profile and increasing availability of medical pregnancy termination drugs, we asked: would the mifepristone–misoprostol regimen for medical termination at ≤10 weeks of gestation meet US Food and Drug Administration regulatory criteria for over‐the‐counter (OTC) approval, and if not, what are the present research gaps? We conducted a literature review of consumer behaviours necessary for a successful OTC application for medical termination at ≤10 weeks of gestation and identified crucial research gaps. If we were to embark on a development programme for OTC or more generally, self‐use of medical termination, the critical elements missing are the label comprehension, self‐selection and actual use studies.Tweetable abstractConsidering medical pregnancy termination through the over‐the‐counter regulatory lens clarifies critical evidence gaps.

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The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: a systematic review

Cited by 46 publications

References 32 publications

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland

Telemedicine for medical abortion: a systematic review

A research agenda for moving early medical pregnancy termination over the counter

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