Surgical or medical abortion of pregnancies between 13+0 and 23+6 weeks' gestation? A systematic review and new NICE national guidelines.
BMJ Sex Reprod Health
; 2020 Mar 17.
Article
em En
| MEDLINE
| ID: mdl-32184291
ABSTRACT
BACKGROUND:
Abortion in the second trimester may be performed surgically or medically. The objective of this systematic review was to examine the effectiveness, safety and acceptability/satisfaction of surgical compared with medical abortion of pregnancy between 13+0 and 23+6 weeks' gestation for a new national guideline.METHODS:
We searched Embase, Medline and the Cochrane Library on 4 March 2019. We included randomised controlled trials (RCTs; any size) and non-randomised comparative studies with n≥100 in each arm, published in English from 1985. Risk-of-bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs)used the Mantel-Haenszel method. The quality of the evidence was assessed using GRADE.RESULTS:
Two RCTs (n=140) were included. 'Incomplete abortion requiring surgical intervention' was clinically significantly higher with medical than surgical methods (RR=4.58, 95% CI 1.07 to 19.64). 'Abortion completed by the intended method' was statistically, but not clinically, significantly lower after medical than surgical methods, but was marked by high between-study heterogeneity (RR=0.88, 95% CI 0.79 to 0.98). To the extent that 'haemorrhage requiring transfusion/≥500 mL blood loss', 'uterine injury', 'cervical injury requiring repair' and 'infection reported within 1 month of abortion' were reported, they did not differ significantly between methods. Depending on measurement method, 'patient satisfaction/acceptability' was either clinically significantly higher or comparable after surgical than medical methods. The quality of this evidence was limited by low event rates and attrition bias.CONCLUSION:
Based on this evidence and consensus, women should be offered the choice of medical or surgical methods of abortion between 13+0 and 23+6 weeks' gestation, unless not clinically appropriate.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Guideline
/
Systematic_reviews
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article