Medical termination for pregnancy in early first trimester (≤ 63 days): a systematic review

Abstract Background A wide range of drugs have been studied for first trimester medical abortion. Studies evaluating different regimens, including combination mifepristone and misoprostol and misoprostol alone regimens, show varying results related to safety, efficacy and other outcomes. Objectives To compare the safety, effectiveness and acceptability of medical abortion and to compare medical methods with surgical methods of abortion ≤ 63 days of gestation. Methods Pubmed and EMBASE were systematically searched from inception through January 2019 using a combination of MeSH, keywords and text words. Randomized controlled trials on induced abortion at ≤ 63 days that compared different regimens of medical abortion using mifepristone and/or misoprostol and trials that compared medical with surgical methods of abortion were included. We extracted data into a pre‐designed form, calculated effect estimates, and performed meta‐analyses where possible. The primary outcomes were ongoing pregnancy and successful abortion. Results Combined regimens using mifepristone and misoprostol had lower rates of ongoing pregnancy and higher rates of successful abortion compared to misoprostol only regimen. Conclusion In this systematic review, we establish medical methods of abortion utilizing combination mifepristone/misoprostol or misoprostol alone are effective, safe and acceptable. In combined regimen, misoprostol 800 μg given vaginally or sublingually had lower rates of ongoing pregnancy and higher rates of successful abortion with moderate certainty of evidence.