Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19.
Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19.
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DOI：
10.1136/bmjgh-2020-003934
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发表时间：
2020-12
影响因子：
8.1
通讯作者：
Ngo TD
中科院分区：
文献类型：
--
作者：
Gambir K;Garnsey C;Necastro KA;Ngo TD
增加家庭药物流产的机会可以为妇女提供一种方便、安全和有效的流产方法，减轻医疗保健系统的负担，并支持在 COVID-19 大流行期间保持社交距离。家庭药物流产被定义为在家服用米非司酮、米索前列醇或两种药物的任何流产。对随机对照试验（RCT）和非随机研究（NRS）进行了系统回顾和荟萃分析。我们检索了从开始到2019年7月10日和2020年6月14日的数据库。成功堕胎是我们感兴趣的主要结果。符合条件的研究是随机对照试验（RCT）和非随机对照试验（NRS）研究，同时进行比较组，比较家庭与诊所的药物流产。计算了风险比 (RR) 及其 95% CI。使用随机效应模型计算估计值。我们使用建议评估、制定和评估分级方法来评估结果的偏倚风险并评估证据的整体质量。我们确定了 6277 项可能符合资格的已发表研究。 19 项研究（3 项随机对照试验和 16 项 NRS）纳入了 11576 名寻求堕胎直至妊娠 9 周的妇女。 RCT 和 NRS 均未发现家庭药物流产和诊所药物流产在成功流产方面存在任何差异（分别为 RR 0.99、95%CI 0.98 至 1.01、I2=0%；RR 0.99、95%CI 0.97 至 1.01、I2=52%）。由于高偏倚风险和发表偏倚，16 个 NRS 的证据质量从低降级至极低。由于偏倚风险较高，三项随机对照试验的证据质量从高降级至中级。家庭药物流产有效、安全且为女性所接受。该证据应用于扩大女性堕胎选择，并确保女性在 COVID-19 期间及之后能够获得堕胎服务。 CRD42020183171。
Increased access to home-based medical abortion may offer women a convenient, safe and effective abortion method, reduce burdens on healthcare systems and support social distancing during the COVID-19 pandemic. Home-based medical abortion is defined as any abortion where mifepristone, misoprostol or both medications are taken at home. A systematic review and meta-analysis of randomised controlled trials (RCTs) and non-randomised studies (NRSs) were conducted. We searched databases from inception to 10 July 2019 and 14 June 2020. Successful abortion was the main outcome of interest. Eligible studies were RCTs and NRSs studies with a concurrent comparison group comparing home versus clinic-based medical abortion. Risk ratios (RRs) and their 95% CIs were calculated. Estimates were calculated using a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess risk of bias by outcome and to evaluate the overall quality of the evidence. We identified 6277 potentially eligible published studies. Nineteen studies (3 RCTs and 16 NRSs) were included with 11 576 women seeking abortion up to 9 weeks gestation. Neither the RCTs nor the NRS found any difference between home-based and clinic-based administration of medical abortion in having a successful abortion (RR 0.99, 95% CI 0.98 to 1.01, I2=0%; RR 0.99, 95% CI 0.97 to 1.01, I2=52%, respectively). The certainty of the evidence for the 16 NRSs was downgraded from low to very low due to high risk of bias and publication bias. The certainty of the evidence for the three RCTs was downgraded from high to moderate by one level for high risk of bias. Home-based medical abortion is effective, safe and acceptable to women. This evidence should be used to expand women’s abortion options and ensure access to abortion for women during COVID-19 and beyond. CRD42020183171.
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DOI：
10.1016/j.ijgo.2009.02.007
发表时间：
2009-07-01
影响因子：
3.8
作者：
Karki, Chanda;Pokharel, Hanoon;Winikoff, Beverly
通讯作者：
Winikoff, Beverly
影响因子：
2.9
作者：
Akin, A;Blum, J;Winikoff, B
通讯作者：
Winikoff, B
影响因子：
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作者：
Irene Drovetta, Raquel
通讯作者：
Irene Drovetta, Raquel
影响因子：
3.8
作者：
Alam, Anadil;Lotarevich, Tatyana;Bracken, Hillary
通讯作者：
Bracken, Hillary
影响因子：
2.9
作者：
Hajri, S;Blum, J;Winikoff, B
通讯作者：
Winikoff, B