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Expulsion at home for early medical abortion: A systematic review with meta-analyses.

早期药物流产在家驱逐: 荟萃分析的系统综述。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14025
  • 作者列表:"Schmidt-Hansen M","Pandey A","Lohr PA","Nevill M","Taylor P","Hasler E","Cameron S
  • 发表时间:2021-04-01
Abstract

INTRODUCTION:The safety and acceptability of medical abortion using mifepristone and misoprostol at home at ≤9+0  weeks' gestation is well established. However, the upper gestational limit at which the procedure remains safe and acceptable at home is not known. To inform a national guideline on abortion care we conducted a systematic review to determine what gestational limit for expulsion at home offers the best balance of benefits and harms for women who are having medical abortion. MATERIAL AND METHODS:We searched Embase, MEDLINE, Cochrane Library, Cinahl Plus and Web-of-Science on 2 January 2020 for prospective and retrospective cohort studies with ≥50 women per gestational age group, published in English from 1995 onwards, that included women undergoing medical abortion and compared home expulsion of pregnancies of ≤9+0  weeks' gestational age with pregnancies of 9+1 -10+0  weeks or >10+1  weeks' gestational age, or compared the latter two gestational age groups. We assessed risk-of-bias using the Newcastle-Ottowa scale. All outcomes were meta-analyzed as risk ratios (RR) using the Mantel-Haenszel method. The certainty of the evidence was assessed using GRADE. RESULTS:Six studies (n = 3381) were included. The "need for emergency care/admission to hospital" (RR = 0.79, 95% confidence interval [CI] 0.45-1.4), "hemorrhage requiring transfusion/≥500 mL blood loss" (RR = 0.62, 95% CI 0.11-3.55), patient satisfaction (RR = 0.99, 95% CI 0.95-1.03), pain (RR = 0.91, 95% CI 0.82-1.02), and "complete abortion without the need for surgical intervention" (RR = 1.03, 95% CI 1-1.05) did not differ statistically significantly between the ≤9+0 and >9+0  weeks' gestation groups. The rates of vomiting (RR = 0.8, 95% CI 0.69-0.93) and diarrhea (RR = 0.85, 95% CI 0.73-0.99) were statistically significantly lower in the ≤9+0  weeks group but these differences were not considered clinically important. We found no studies comparing pregnancies of 9+1 -10+0  weeks' gestation with pregnancies of >10+0  weeks' gestation. The certainty of this evidence was predominantly low and mainly compromised by low event rates and loss to follow up. CONCLUSIONS:Women who are having a medical abortion and will be taking mifepristone up to and including 10+0  weeks' gestation should be offered the option of expulsion at home after they have taken the misoprostol. Further research needs to determine whether the gestational limit for home expulsion can be extended beyond 10+0  weeks.

摘要

引言: 在妊娠 ≤ 9 + 0周时,在家使用米非司酮和米索前列醇进行药物流产的安全性和可接受性已得到公认。然而,该手术在家庭中保持安全和可接受的妊娠上限尚不清楚。为了给国家堕胎护理指南提供信息,我们进行了一项系统回顾,以确定在家驱逐的妊娠限制为药物流产妇女提供了最佳的利益和伤害平衡。 材料和方法: 我们于2020年1月2日检索了Embase、MEDLINE、Cochrane Library、Cinahl Plus和Web-of-Science,检索了自1995年起以英文发表的每个胎龄组 ≥ 50名妇女的前瞻性和回顾性队列研究。这包括接受药物流产的妇女,并比较了 ≤ 9 + 0周妊娠与9 + 1 -10 + 0周妊娠或> 10 + 1周妊娠的家庭分娩,或比较了后两个孕龄组.我们使用纽卡斯尔-奥托瓦量表评估偏倚风险。使用Mantel-Haenszel方法以风险比 (RR) 对所有结局进行荟萃分析。使用GRADE评估证据的确定性。 结果: 共纳入6项研究 (n = 3381)。“需要急诊/入院” (RR = 0.79,95% 置信区间 [CI] 0.45-1.4) 、 “需要输血的出血/≥ 500 mL失血” (RR = 0.62,95% CI 0.11-3.55) 、患者满意度 (RR = 0.99,95% CI 0.95-1.03) 、疼痛 (RR = 0.91,95% CI 0.82-1.02) 、并且 “完全流产而不需要手术干预” (RR = 1.03,95% CI 1-1.05) 在 ≤ 9 + 0和> 9 + 0周妊娠组之间没有统计学显著差异。在 ≤ 9 + 0周组中,呕吐 (RR = 0.8,95% CI 0.69-0.93) 和腹泻 (RR = 0.85,95% CI 0.73-0.99) 的发生率在统计学上显著较低,但这些差异不被认为是临床上重要的。我们没有发现比较9 + 1 -10 + 0周妊娠与> 10 + 0周妊娠的研究。该证据的确定性主要较低,主要受到低事件发生率和失访的影响. 结论: 正在进行药物流产并将服用米非司酮直至妊娠10 + 0周的妇女应在服用米索前列醇后在家中选择驱逐。进一步的研究需要确定家庭驱逐的妊娠限制是否可以延长超过10 + 0周。

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