Medical versus surgical methods for first trimester termination of pregnancy

 

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 methods

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

Seven 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 availbale 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.

 

Plain language summary

Medical methods for early termination of pregnancy can be safe and effective.

There are several different surgical techniques for early termination of pregnancy (abortion in the first three months). Several drugs can also be prescribed alone or in combination to terminate early pregnancy. This is called medical abortion, and uses the hormones prostaglandins and/or mifepristone (an antiprogesterone often called RU486), and/or methotrexate. The review of trials found that medical methods for abortion in early pregnancy can be safe and effective, with the most evidence of effectiveness for a combination of mifepristone and misoprostol (a prostaglandin). Almost all of the trials were done in well-resourced hospitals where women returned for check-up.

 

摘要

背景

第一孕期人工流產之藥物或手術處理

人工流產已廣泛應用於全世界.除了以手術方式施行,過去十年亦發展出多種藥物流產方式.在此篇回顧中,我們有系統的由多篇隨機臨床試驗,搜尋分析並比較手術與藥物流產.

目標

來評估比較藥物與手術方式對於第一孕期人工流產的效率,副作用,以及接受度.

搜尋策略

考科藍實症醫學資料庫系統化搜尋了MEDLINE(以考科藍三階段搜尋策略,包含1966至2000年的文獻)以及Popline (1970至2000年的文獻).搜尋上並沒有語言偏好.我們並且搜尋了參考文獻中的每一篇報告,並與WHO/HRP的專家接洽.

選擇標準

有關以手術方式及藥物方式施行第一孕期人工流產的任何隨機試驗

資料收集與分析

試驗的品質及數據分別由兩位專家獨立審核

主要結論

七篇研究報告中,(其中多數為小規模研究),比較了四種人工流產藥物之使用與手術流產(單獨使用prostaglandins,單獨使用mifepristone,合併使用mifepristone/misoprostol,合併使用methotrexate/misoprostol,與真空吸引手術的比較)有些結果只根據其中一項研究.以使用prostaglandins與真空吸引術相比,前者造成不完全性流產的比率要高於真空吸引術,且具有統計上差異(2.7,95% CI 1.1 – 6.8).至於以目前最常使用的mifepristone合併使用misoprostol的藥物流產方式,來與手術流產相比,則還沒有數據.人工流產後陰道出血的持續時間,藥物流產要比手術流產來的長.手術流產組中,只有一篇報告提到一個案例發生主要併發症(子宮穿孔).在後續的追蹤中,之後的懷孕或骨盆腔感染率在藥物或手術組中並無差別.在此篇回顧中,並無對於兩種人工流產方式的接受度,副作用,或婦女滿意度的資料.

作者結論

此篇結論是由較為小型的試驗延伸獲得.僅用prostadlanding單方來施行第一孕期人工流產相較以手術方式流產,其效果較差且較疼痛.然而,並沒有適當的證據可供對兩種流產方式的接受度以及副作用做評論.我們需要進一步更可信的研究來探討近年來各流產方式的效果以及婦女喜好的方式.(註:原文引用錯誤以致翻譯錯誤;“Say Lale, Brahmi Dalia, Kulier Regina, Campana Aldo, Gulmezoglu A Metin”怎麼會是作者結論呢)

翻譯人

本摘要由臺灣大學附設醫院陳怡伶翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以藥物方式行較早妊娠週數的人工流產是安全有效的.有多種手術方式可用以早期懷孕(懷孕前三個月)的人工流產.多種藥物可單獨或合併使用於中止早期妊娠.使用荷爾蒙, prostaglandins,或合併/單獨使用mifepristone(一種抗黃體素藥物,也就是RU486)或合併/單獨使用methotrexate,這些就是所謂的葯物流產.此篇回顧指出,藥物流產中使用mifepristone合併misoprostol(一種前列腺素)對於較小週數懷孕的人工流產是最為安全有效的.此篇回顧中所有的試驗都是在能讓病人做完整追蹤的醫院進行.