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
. 2019 Dec;126(13):1536-1544.
doi: 10.1111/1471-0528.15922. Epub 2019 Sep 18.

Effectiveness, safety and acceptability of self-assessment of the outcome of first-trimester medical abortion: a systematic review and meta-analysis

N Baiju  1 , G Acharya  2   3 , F D'Antonio  2 , R C Berg  1   4
Affiliations
Meta-Analysis

Effectiveness, safety and acceptability of self-assessment of the outcome of first-trimester medical abortion: a systematic review and meta-analysis

N Baiju et al. BJOG. 2019 Dec.

Abstract

Background: For many women, the need for multiple clinical visits is a barrier to medical abortion.

Objectives: We assessed the effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home versus routine clinic follow up after medical abortion.

Search strategy: We searched databases such as MEDLINE, Embase, and CENTRAL to find studies published in 1991-2018.

Selection criteria: Eligible studies included women of reproductive age who had undergone a medical abortion that was completed at home. The intervention and self-assessment of the outcome of medical abortion done by urine pregnancy tests kits by women at home was compared with routine medical follow up at a clinic.

Data collection and analysis: Two researchers completed the study selection, data extraction, critical appraisal, and assessment of the evidence. The outcomes were successful complete abortions, side effects and complications, and acceptability. We performed meta-analyses when possible and GRADE to ascertain the certainty of the evidence. The protocol was registered in PROSPERO (CRD42017055316).

Main results: Four randomised controlled trials (RCTs; n = 5493) met our inclusion criteria. The pooled analysis from all studies showed no significant difference in complete abortion rates between self-assessment and routine clinic follow up: RR = 1.00, 95% CI 0.99-1.01. The ongoing pregnancy rates were similar and the pooled results for the safety outcomes showed no significant differences between the groups. There was a significantly greater preference for self-assessment as the follow-up method.

Conclusions: The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home are not inferior to routine clinic follow up.

Tweetable abstract: The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion are not inferior to routine clinic follow up.

Keywords: Abortion; home; pregnancy test; self-assessment; systematic review.

PubMed Disclaimer

Comment in

References

    1. Raymond EG, Tan YL, Grant M, Benavides E, Reis M, Sacks DN, et al. Self-assessment of medical abortion outcome using symptoms and home pregnancy testing. Contraception 2017;11:11.
    1. Dunn S, Cook R. Medical abortion in Canada: behind the times. Can Med Assoc J 2014;186:13-4.
    1. WHO. Safe Abortion: Technical and Policy Guidance for Health Systems. Geneva: World Health Organization 2012;20:205-207.
    1. Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V. Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days. Contraception 2009;80:282-6.
    1. Paul M, Lichtenberg S, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. London: John Wiley & Sons; 2011.

Substances

LinkOut - more resources