Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2005 Jan 25;2002(1):CD003037.
doi: 10.1002/14651858.CD003037.pub2.

Medical versus surgical methods for first trimester termination of pregnancy

L Say  1 , R Kulier, M Gülmezoglu, A Campana
Affiliations
Meta-Analysis

Medical versus surgical methods for first trimester termination of pregnancy

L Say et al. Cochrane Database Syst Rev. .

Abstract

Background: Induced abortions are very commonly practiced interventions worldwide. A variety of medical abortion methods have been introduced during the last decade in addition to existing surgical methods. In this review we systematically searched for and combined all evidence from randomised controlled trials comparing surgical with medical abortion.

Objectives: To evaluate medical methods in comparison to surgical methods for first-trimester abortion with respect to efficacy, side effects and acceptability.

Search strategy: The Cochrane Controlled Trials Register, MEDLINE (with the Cochrane 3-stage search strategy)(1966-2000) and Popline (1970-2000) were systematically searched. There were no language preferences in searching. Reference lists of retrieved papers were searched. Experts in WHO/HRP were contacted.

Selection criteria: Randomised trials of any surgical abortion method compared with any medical abortion method in the first trimester.

Data collection and analysis: Trial quality was assessed and data extraction was made independently by two reviewers.

Main results: Six studies mostly with small sample sizes, comparing 4 different interventions (prostaglandins alone, mifepristone alone, and mifepristone/misoprostol and methotrexate/misoprostol versus vacuum aspiration) were included. Results are sometimes based on one trial only. Prostaglandins vs vacuum aspiration: the rate of abortions not completed with the intended method was statistically significant higher in the prostaglandin group (2.7, 95% CI 1.1 to 6.8) compared to surgery. There are no data on the most commonly medical (mifepristone/misoprostol) and surgical abortion available to be included in the review. Duration of bleeding was longer in the medical abortion groups compared to vacuum aspiration. There was only one major complication (uterine perforation) in one trial in the surgical group. There was no difference between the groups for ongoing pregnancies at the time of follow-up or pelvic infections. No data on acceptability, side effects or women's satisfaction with the procedure were available for inclusion in the review.

Authors' conclusions: The results are derived from relatively small trials. Prostaglandins used alone seems to be less effective and more painful compared to surgical first-trimester abortion. However, there is inadequate evidence to comment on the acceptability and side effects of medical compared to surgical first-trimester abortions. There is a need for trials to address the efficacy of currently used methods and women's preferences more reliably.

PubMed Disclaimer

Conflict of interest statement

None known

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Ashok 2002 {published data only}
    1. Ashok PW, Kidd A, Flett GMM, Fitzmaurice A, Graham W, Templeton A. A randomized comparison of medical abortion and surgical vacuum aspiration at 10‐13 weeks gestation. Human Reproduction 2002;17(1):92‐8. - PubMed
Creinin 2000 {published data only}
    1. Creinin MD. Randomised comparison of efficacy, acceptability and cost of medical versus surgical abortion. Contraception 2000;62:117‐24. - PubMed
Henshaw 1994 {published data only}
    1. Henshaw RC, Naji SA, Russall IT, Templeton AA. A comparison of medical abortion (using mifepristone and gemeprost) with surgical vacuum aspiration: efficacy and early medical sequelae. Human Reproduction 1994;9(11):2167‐72. - PubMed
Legarth 1991 {published data only}
    1. Legarth J, Peen UBS, Michelsen JW. Mifepristone or vacuum aspiration in termination of early pregnancy. European Journal of Obstetrics&Gynaecology and Reproductive Biology 1991;41:91‐6. - PubMed
Rorbye 2004 {published data only}
    1. Rorbye C, Norgaard M, Nilas L. Medical versus surgical abortion efficacy, complications and leave of absence in a partly randomized study. Contraception 2004;70:393‐399. - PubMed
Rosen 1984 {published data only}
    1. Rosen AS, Knorring K, Bygdeman M, Christensen J. Randomised comparison of prostaglandin treatment in hospital or at home with vacuum aspiration for termination of early pregnancy. Contraception 1984;29(5):423‐35. - PubMed
WHO 1987 {published data only}
    1. Task Force on Post‐ovulatory Methods for Fertility Regulation. Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization. Menstrual regulation by intramuscular injections of 16‐phenoxy‐tetranor PGE2 methyl sulfonylamide or vacuum aspiration. A randomized multicentre study. British Journal of Obstetrics and Gynaecology 1987;94:949‐56. - PubMed

References to studies excluded from this review

Prasad 2009 {published data only}
    1. Prasad S, Kumar A, Divya A. Early termination of pregnancy by single‐dose 800 µg misoprostol compared with surgical evacuation. Fertility and Sterility 2009;91(1):28‐31. - PubMed
Rosen 1979 {published data only}
    1. Rosen A, Nystedt L, Bygdeman M, Lundstrom V. Acceptability of a nonsurgical method to terminate very early pregnancy in comparison to vacuum aspiration. Contraception 1979;19(2):107‐17. - PubMed

Additional references

Blanchard 1999
    1. Blanchard K, Winikoff B, Ellertson C. Misoprostol used alone for the termination of early pregnancy. Contraception 1999;59:209‐217. - PubMed
Blumenthal 1991
    1. Blumenthal PD. Abortion. Curr Opin Obstet Gynecol 1991;3(4):496‐500. - PubMed
Grimes 1979
    1. Grimes DA, Cates N. Complications from legally induced abortion: a review. Obstet Gynecol Surv 1979;34(3):177‐191. - PubMed
Grimes 1997
    1. Grimes DA. Medical abortion in early pregnancy: a review of the evidence. Obstet Gynecol 1997;89:790‐796. - PubMed
Gupta 1998
    1. Gupta S. Early non‐surgical abortion‐give women the choice. Hum Reprod 1998;13(9):2379‐2381. - PubMed
Henshaw 1999
    1. Henshaw SK, Singh S, Haas T. The incidence of abortion worldwide. Int Fam Plann Perspect 1999;25(Suppl):30‐38. - PubMed
Mundigo 1999
    1. Mundigo AI, Indriso C, editors. Abortion in the developing world. First Edition. New Delhi: WHO, Vistar Publications, 1999.
Singh 1998
    1. Singh K, Ratnam SS. The influence of abortion legislation on maternal mortality. Int J Gynecol Obstet 1998;63(Suppl 1):S123‐129. - PubMed
Slade 1998
    1. Slade P, Heke S, Fletcher J, Stewart P. A comparison of medical and surgical termination of pregnancy: choice, emotional impact and satisfaction with care. Br J Obstet Gynaecol 1998;105:1288‐1295. - PubMed
Thong 1992
    1. Thong KJ, Dewar MH, Baird DT. What do women want during medical abortion. Contraception 1992;46:435‐442. - PubMed
WHO 1997
    1. WHO Scientific Group. Medical methods for termination of pregnancy. WHO Technical Report Series: 871. Geneva: WHO, 1997. - PubMed
Wiebe 1993
    1. Wiebe ER. Choosing between surgical abortions and medical abortions induced with methotrexate and misoprostol. Contraception 1993;48:339‐347. - PubMed
Winikoff 1996
    1. Winikoff B, Ellerston C, Clark S. Analysis of failure in medical abortion. Contraception 1996;54:323‐327. - PubMed

Substances