Background: Medical abortion with mifepristone and misoprostol usually involves an interval of 36-48 hours between administering these drugs; however, it is possible that the clinical efficacy at early gestations may be maintained when the drugs are taken simultaneously. The objective of this systematic review was to determine the safety and effectiveness of simultaneous compared with interval administration of mifepristone and misoprostol for abortion up to 10 weeks' gestation.
Methods: We searched Embase Classic, Embase; Ovid MEDLINE(R) including Daily, and Epub Ahead-of-Print, In-Process & Other Non-Indexed Citations; and Cochrane Library on 11 December 2019. We included randomised controlled trials (RCTs), published in English from 1985, comparing simultaneous to interval administration of mifepristone and misoprostol for early abortion. Risk of bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs) using the Mantel-Haenszel method were performed. The quality of the evidence was assessed using GRADE.
Results: Meta-analyses of three RCTs (n=1280) showed no differences in 'ongoing pregnancy' (RR 1.78, 95% CI 0.38 to 8.36), 'haemorrhage requiring transfusion or ≥500 mL blood loss' (RR 0.11, 95% CI 0.01 to 2.03) and 'incomplete abortion with the need for surgical intervention' (RR 1.30, 95% CI 0.76 to 2.25) between the interventions. Individual study results showed no difference in patient satisfaction, or 'need for repeat misoprostol', although 'time to onset of bleeding or cramping' was longer after simultaneous than interval administration. The quality of evidence was very low to moderate.
Conclusion: The published data support the use of simultaneous mifepristone and misoprostol for medical abortion up to 9 weeks in women who prefer this method of administration.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1136/bmjsrh-2019-200448 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Objective: Early pregnancy loss is a common complication of pregnancy. Research has demonstrated the efficacy of Mifepristone pre-treatment followed by Misoprostol for the induction of an early pregnancy loss (EPL). North York General Hospital (NYGH) provides an all-in-one Early Pregnancy Assessment Clinic (EPAC) to streamline the care of women with an EPL.
View Article and Find Full Text PDFA Proof-of-Concept Study of Ulipristal Acetate for Early Medication Abortion.
NEJM Evid
February 2025
Gynuity Health Projects, New York.
Background: The current regimen for early medication abortion in many countries is mifepristone and misoprostol, but mifepristone is relatively expensive and limited in many regions. Ulipristal acetate, with a similar chemical profile, might be an alternative. This proof-of-concept study evaluated ulipristal acetate and misoprostol for medication abortion through 63 days of gestation.
View Article and Find Full Text PDFAccuracy of Survey-Based Assessment of Eligibility for Medication Abortion Compared to Clinician Assessment.
Am J Obstet Gynecol
January 2025
University of California, San Francisco, San Francisco, CA.
Background: With increasingly restricted access to facility-based abortion in the United States, pregnant people are increasingly relying on models of care that utilize history-based or no-test approaches to eligibility assessment. Minimal research has examined the accuracy of abortion patients' self-assessment of eligibility for medication abortion using their health history, a necessary step towards ensuring optimal access to history-based or no-test models, as well as potential over-the-counter access.
Objective: To examine the accuracy of pregnant people's eligibility for medication abortion determined using their self-reported health history as compared to clinician assessment with ultrasound and other tests.
Medical Termination of Pregnancy: Law and Controversies in the United States and Australia.
J Law Med
November 2024
Barrister, Castan Chambers, Melbourne, Australia; Professor of Law and Professorial Fellow in Psychiatry, University of Melbourne; Honorary Professor of Forensic Medicine, Monash; Adjunct Professor, Southern Cross University.
This editorial reviews the changes over two decades in the United States and Australia in relation to the law governing access to drugs enabling medical termination of pregnancy. It also scrutinises three contentious decisions by the United States Supreme Court between 2022 and 2024 in relation to abortion. It argues that the receptive environment in the United States Supreme Court, as it is currently constituted, to challenges to the lawfulness of terminations of pregnancy and abortion medications is likely to inspire comparable challenges as part of the "Abortion Wars" in other countries, including Australia.
View Article and Find Full Text PDFQuality of care offered by health care retail markets for medication abortion self-management: Findings from states in Nigeria and India.
PLOS Glob Public Health
January 2025
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Dispensing of misoprostol and mifepristone by pharmacies and chemist shops for self-management of medication abortion (MA) fills a crucial gap in settings where abortion care by trained health professionals is not readily available. This promising service delivery pathway, endorsed by the World Health Organization (WHO), is hindered by concerns of poor-quality care. Simulated clients collected data on MA pill dispensing practices from 92 pharmacies and chemist shops in three Nigerian states and 127 pharmacies in an Indian state that we have anonymized.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!