Home use of mifepristone for medical abortion: a systematic review

Abstract

Background: In many countries, persons seeking medical abortion with mifepristone followed by misoprostol can self-administer the second drug, misoprostol, at home, but self-administration of the first drug, mifepristone, is not allowed to the same extent.

Objectives: This systematic review aims to evaluate whether the efficacy, safety and women's satisfaction with abortion treatment are affected when mifepristone is self-administered at home instead of in a clinic.

Search strategy: A literature search covered CINAHL, Cochrane Library, Embase, Ovid MEDLINE and APA PsycInfo in October 2022.

Selection criteria: Eligible studies focused on persons undergoing medical abortion comparing home and in-clinic mifepristone intake. Outcomes included abortion effectiveness, compliance, acceptability, and practical consequences for women.

Data collection and analysis: Two reviewers independently assessed eligibility and risk of bias. Meta-analysis included similar studies while those differing in design were synthesised without meta-analysis.

Results: Six studies (54 233 women) of medical abortions up to 10 weeks were included. One randomised controlled trial and one retrospective register study had moderate risk of bias, and four non-randomised clinical trials where women could choose the place for intake of mifepristone had serious risk of bias. There was no difference in abortion effectiveness (high confidence) or compliance (moderate confidence) between mifepristone administered at home or in-clinic. No differences in complications were detected between groups and most women who chose home administration of mifepristone expressed a preference for this approach.

Conclusions: Our systematic review demonstrates that the effectiveness of medical abortion is comparable regardless of mifepristone administration and intake, at home or in the clinic.

Keywords: Abortifacient Agents; Mifepristone; abortion.

Figure 1. Flowchart presenting the selection process after the literature search.

Figure 2. Meta-analyses of studies comparing the proportion of women with (a) complete abortion, (b) incomplete abortion, and (c) ongoing pregnancy when mifepristone is administered at home or at a clinic. Differences presented as absolute risks. NRCT, non-randomised clinical trial; RCT, randomised controlled trial.

Figure 3. Proportion of women taking mifepristone at home compared with at a clinic who made (a) unplanned phone calls to the clinic or (b) unplanned visits to healthcare providers. NRCT, non-randomised clinical trial; RCT, randomised controlled trial.