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Medical regimens for abortion at 12 weeks and above: a systematic review and meta-analysis. [Review]

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Citation: Contraception: X. 2:100037, 2020.PMID: 32954250Institution: MedStar Washington Hospital CenterDepartment: Obstetrics and GynecologyForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020 ISSN:

2590-1516

Name of journal: Contraception: XAbstract: Background: Mifepristone and misoprostol are recommended for second-trimester medical abortion, but consensus is unclear on the ideal regimen.Conclusion: Our analysis supports the use of mifepristone 200mg 1 to 2 days before misoprostol 400 mcg vaginally every 3h at >= 12weeks' gestation.Data sources: We searched PubMed, Popline, Embase, Global Index Medicus, Cochrane Controlled Register of Trials and International Clinical Trials Registry Platform from January 2008 to May 2017.Implications: Where available, providers should use mifepristone plus misoprostol for second-trimester medical abortion. Vaginal misoprostol appears to be most efficacious with fewest side effects, but sublingual and buccal routes are also acceptable. Copyright (c) 2020 World Health Organization; licensee Elsevier.Limitations: Direct comparisons of buccal misoprostol to sublingual or vaginal routes after mifepristone were limited. Evidence from clinical trials on how to best manage women with prior uterine incisions was lacking.Objectives: The objectives were to systematically review randomized controlled trials (RCTs) investigating efficacy, safety and satisfaction of medical abortion at >= 12weeks' gestation.Results: We included 43 of the 1894 references identified. Combination mifepristone-misoprostol had lower rates of OP [risk ratio (RR) 0.12, 95% confidence interval (CI) 0.04-0.35] vs. misoprostol only. A 24-h interval between mifepristone and misoprostol had lower OP rate at 24h than simultaneous dosing (RR 3.13, 95% CI 1.23-7.94). Every 3-h dosing had lower OP rate at 48h (RR 0.39, 95% CI 0.17-0.88).Study appraisal and synthesis methods: After extracting prespecified data and assessing risk of bias in accordance with the Cochrane handbook, we used Revman5 software to combine data and GRADE to assess certainty of evidence.Study eligibility participants and interventions: We included RCTs on medical abortion at >= 12weeks' gestation using mifepristone and/or misoprostol. We excluded studies with spontaneous abortion, fetal demise and mechanical cervical ripening and those not reporting ongoing pregnancy (OP).All authors: Brant A, Fonhus MS, Ganatra B, Lavelanet A, Whitehouse KFiscal year: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.conx.2020.100037

Date added to catalog: 2020-10-06

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Title notes ( 10 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	32954250	Available		32954250

Background: Mifepristone and misoprostol are recommended for second-trimester medical abortion, but consensus is unclear on the ideal regimen.

Conclusion: Our analysis supports the use of mifepristone 200mg 1 to 2 days before misoprostol 400 mcg vaginally every 3h at >= 12weeks' gestation.

Data sources: We searched PubMed, Popline, Embase, Global Index Medicus, Cochrane Controlled Register of Trials and International Clinical Trials Registry Platform from January 2008 to May 2017.

Implications: Where available, providers should use mifepristone plus misoprostol for second-trimester medical abortion. Vaginal misoprostol appears to be most efficacious with fewest side effects, but sublingual and buccal routes are also acceptable. Copyright (c) 2020 World Health Organization; licensee Elsevier.

Limitations: Direct comparisons of buccal misoprostol to sublingual or vaginal routes after mifepristone were limited. Evidence from clinical trials on how to best manage women with prior uterine incisions was lacking.

Objectives: The objectives were to systematically review randomized controlled trials (RCTs) investigating efficacy, safety and satisfaction of medical abortion at >= 12weeks' gestation.

Results: We included 43 of the 1894 references identified. Combination mifepristone-misoprostol had lower rates of OP [risk ratio (RR) 0.12, 95% confidence interval (CI) 0.04-0.35] vs. misoprostol only. A 24-h interval between mifepristone and misoprostol had lower OP rate at 24h than simultaneous dosing (RR 3.13, 95% CI 1.23-7.94). Every 3-h dosing had lower OP rate at 48h (RR 0.39, 95% CI 0.17-0.88).

Study appraisal and synthesis methods: After extracting prespecified data and assessing risk of bias in accordance with the Cochrane handbook, we used Revman5 software to combine data and GRADE to assess certainty of evidence.

Study eligibility participants and interventions: We included RCTs on medical abortion at >= 12weeks' gestation using mifepristone and/or misoprostol. We excluded studies with spontaneous abortion, fetal demise and mechanical cervical ripening and those not reporting ongoing pregnancy (OP).

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