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Clinical Scenario
A 34-year-old patient, gravida 3, para 2, has an unplanned pregnancy and requests referral for abortion. Her last menstrual period began 39 days ago. She asks what you know about "the abortion pill."
Cochrane Abstract
Background. Surgical abortion by vacuum aspiration or dilatation and curettage up to 63 days' gestation has been the method of choice since the 1960s. Medical abortion became an alternative method of first-trimester pregnancy termination with the availability of prostaglandins in the early 1970s and anti-progesterones in the 1980s. The most widely researched drugs are prostaglandins alone, mifepristone alone, methotrexate alone, mifepristone with prostaglandins, and methotrexate with prostaglandins.
Objectives. To compare different medical methods for first-trimester abortion.
Search Strategy. The authors' searched the Cochrane Controlled Trials Register, MEDLINE, and Popline. Reference lists of retrieved papers also were searched. Experts in the World Health Organization Human Reproduction Programme were contacted.
Selection Criteria. Randomized controlled trials comparing different methods (e.g., single-drug and combination regimens), methods of application, or dosage regimens for medical abortion were considered. After assessment, trials were included if they had adequate randomization procedure, concealment of allocation, and follow-up. Women in the first trimester of pregnancy who were undergoing medical abortion were the participants. Different medical methods used for first-trimester abortion, compared with each other or placebo, were included. Outcomes included mortality, failure to achieve complete abortion, surgical evacuation (as emergency procedure, non-emergency procedure, or undefined), ongoing pregnancy at follow-up, time until passing of conceptus (more than three to six hours), blood transfusion, blood loss (measured or clinically relevant drop in hemoglobin), days of bleeding, pain resulting from the procedure (reported by the women or measured by use of analgesics), additional uterotonics used, women's dissatisfaction with the procedure, nausea, vomiting, and diarrhea.
Data Collection and Analysis. Two reviewers independently selected trials for inclusion from the results of the search strategy described previously. Trials under consideration were evaluated for appropriateness for inclusion and methodologic quality without consideration of their results. A form was designed to facilitate the data extraction. Data were processed using Revman software.
Primary Results. Thirty-nine trials were included in the review. Unless otherwise stated, the effectiveness outcomes refer to failure to achieve complete abortion with the intended method.
Mifepristone in a dosage of 600 mg...