Surgical versus medical methods for second trimester induced abortion

  • Review
  • Intervention

Authors


Abstract

Background

Determining the optimal method of performing second-trimester abortions is important, since they account for a disproportionate amount of abortion-related morbidity and mortality.

Objectives

To compare surgical and medical methods of inducing abortion in the second trimester of pregnancy with regard to efficacy, side effects, adverse events, and acceptability.

Search methods

We identified trials using Pub Med, EMBASE, POPLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL). We also searched the reference lists of identified studies, relevant review articles, book chapters, and conference proceedings for additional, previously unidentified studies. We contacted experts in the field for information on other published or unpublished research.

Selection criteria

Randomised trials comparing any surgical to any medical method of inducing abortion at ≥ 13 weeks' gestation were included.

Data collection and analysis

We assessed the validity of each study using the methods suggested in the Cochrane Handbook. Investigators were contacted as needed to provide additional information regarding trial conduct or outcomes. Two reviewers abstracted the data. Odds ratios and 95% confidence intervals were calculated for dichotomous variables using RevMan 4.2. The trials did not have uniform interventions, therefore, we were unable to combine them into a meta-analysis.

Main results

Two studies met criteria for this review. One compared dilation and evacuation (D&E) to intra-amniotic instillation of prostaglandin F2 α. The second study compared D&E to induction with mifepristone and misoprostol. Compared with prostaglandin instillation, the combined incidence of minor complications was lower with D&E (OR 0.17, 95% CI 0.04-0.65) as was the total number of minor and major complications (OR 0.12, 95% CI 0.03-0.46). The number of women experiencing adverse events was also lower with D&E than with mifepristone and misoprostol (OR 0.06, 95% CI 0.01-0.76). Although women treated with mifepristone and misoprostol reported significantly more pain than those undergoing D&E, efficacy and acceptability were the same in both groups. In both trials, fewer subjects randomised to D&E required overnight hospitalisation.

Authors' conclusions

Dilation and evacuation is superior to instillation of prostaglandin F2 α. The current evidence also appears to favour D&E over mifepristone and misoprostol, however larger randomised trials are needed.

摘要

背景

手術和藥物用在第二孕期引產的方法

選擇一個理想的方法做第第二孕期的人工流產是很重要的,因為這個時期的流產容易造成較高的罹病率和死亡率。

目標

主要在比較在第二孕期人工引產的手術或藥物方法,包括效果、副作用、不良反應和接受程度。

搜尋策略

我們根據的試驗是搜尋自EMBASE、POPLINE和 the Cochrane Central Register of Controlled Trials (CENTRAL)。 我們也搜尋已知研究中引用的參考文獻,相關回顧性文章,相關書籍章節,及一些以前未知研究的會議紀錄。我們與這個領域的專家聯繫,以取得其他已發表或未發表的相關資訊。

選擇標準

比較任何手術或藥物人工流產方法的隨機試驗,納入的妊娠大小是13週。

資料收集與分析

我們用考科藍手冊建議的方法來評估每一個研究的效力。如果需要的話,會從研究者那裡取得關於實驗處理方式或結果的詳細資料。有二個回顧作者統整實驗數據。二分變項用RevMan 4.2軟體計算勝算比和95%信賴區間。這些試驗並沒有做一致的處置,因此,我們無法用統合分析的方法來做比較。

主要結論

有兩個試驗符合這篇回顧性文章。一篇在比較擴張抽吸術(D&E)和羊水內灌注前列腺素(prostaglandin F2)。第二篇研究在比較擴張抽吸術和RU486加上misoprostol. 和羊水內灌注前列腺素的方法比起來,擴張抽吸術的輕微併發症發生率較低(勝算比0.17,95%CI 0.04−0.65),所有輕微及嚴重併發症(勝算比0.12,95%CI 0.03−0.46)也較低。而用擴張抽吸術有發生不良反應的人也比用RU486加上misoprostol的少(勝算比0.06,95%CI 0.01−0.76)。雖然用RU486加上misoprostol的人統計出來疼痛程度比用擴張抽吸術高,但效果和接受度在二組是相同的。在這兩個試驗中都有提到,有少部分隨機接受擴張抽吸術的人需要術後住院觀察一晚。

作者結論

擴張抽吸術被認為比羊水內灌注前列腺素要好。目前的證據也顯示擴張抽吸術比用RU486加上misoprostol好,不過仍需大規模的隨機試驗證實。

翻譯人

本摘要由臺灣大學附設醫院劉惠珊翻譯。

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

總結

妊娠三個月後的人工流產可以用手術或藥物的方式。這篇摘要主要在比較那一種方式比較好。我們用網路搜尋比較任何手術和任何藥物在這個時期用來做人工流產的研究。我們也聯絡研究者和查閱書目章節以及其他文章來搜集更多研究。我們找到了兩個研究。第一篇在比較擴張抽吸術和羊水內灌注前列腺素。第二篇研究在比較擴張抽吸術和口服以及陰道塞劑。擴張抽吸術比子宮灌注藥物的方法好。口服以及陰道塞劑的效果和接受度和擴張抽吸術差不多,但會造成較多疼痛和副作用。我們需要更多關於妊娠三個月後人工流產的最新醫學研究。

Plain language summary

Abortion after three months of pregnancy can be done by an operation or with medicines. This review looked at which way is better.

We did computer searches to find studies that compared any operation to any medicine used for abortion at this stage of pregnancy. We wrote to researchers and looked through book chapters and other articles to find more studies.

We found two studies. The first compared dilation and evacuation (D&E) to injecting a drug into the pregnant womb. The second compared D&E to drugs taken by mouth and by vagina.

The D&E operation was better than injecting medicines into the womb. Medicines taken by mouth and vagina worked as well and were as acceptable as a D&E, but caused more pain and side effects. More studies with modern medicines used for abortion after 3 months of pregnancy are needed.

Ringkasan bahasa mudah

Pengguguran selepas tiga bulan pertama boleh dijalankan melalui kaedah pembedahan atau perubatan.Ulasan ini bertujuan untuk menilai kaedah mana yang lebih baik.

Kami mencari kajian-kajian yang membandingkan sebarang kaedah pembedahan dengan ubat-ubatan yang digunakan untuk pengguguran dalam fasa kehamilan ini menggunakan komputer untuk mencari kajian yang diterbitkan dalam talian. Kami juga menulis kepada para pengkaji dan mencari kajian di dalam buku dan artikel untuk mendapatkan maklumat yang lebih banyak.

Kami menemukan dua kajian. Kajian yang pertama membandingkan antara pendilatan dan evakuasi dengan penyuntikan ubat ke dalam rahim. Kajian yang kedua pula membandingkan pendilatan dan evakuasi dengan ubat-ubat yang diambil melalui mulut atau dimasukkan ke dalam faraj.

Pembedahan pendilatan dan evakuasi lebih baik daripada penyuntikan ubat ke dalam rahim. Ubat-ubat yang diambil melalui mulut dan dimasukkan ke dalam faraj berkesan dan tahap penerimaan yang sama dengan dengan D&E, tetapi lebih menyakitkan dan lebih banyak kesan sampingan. Lebih banyak kajian dengan menggunakan ubat-ubat moden bagi pengguguran selepas tiga bulan mengandung diperlukan.

Catatan terjemahan

Diterjemahkan oleh Tan Wing (Melaka Manipal Medical College). Disunting oleh Rosnani Zakaria (Universiiti Sains Malaysia). Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi jame5wtan93@gmail.com

Ancillary