Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19

Background 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, mis...

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Autores principales:	Katherine Gambir, Camille Garnsey, Kelly Ann Necastro, Thoai D Ngo
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2020
Materias:	Medicine (General) R5-920 Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/ce2e457fb78e40dd954f9c929db456c1
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spelling	oai:doaj.org-article:ce2e457fb78e40dd954f9c929db456c12021-11-19T07:00:05ZEffectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-1910.1136/bmjgh-2020-0039342059-7908https://doaj.org/article/ce2e457fb78e40dd954f9c929db456c12020-12-01T00:00:00Zhttps://gh.bmj.com/content/5/12/e003934.fullhttps://doaj.org/toc/2059-7908Background 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.Methods 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.Results 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.Conclusion 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.PROSPERO registration number CRD42020183171.Katherine GambirCamille GarnseyKelly Ann NecastroThoai D NgoBMJ Publishing GrouparticleMedicine (General)R5-920Infectious and parasitic diseasesRC109-216ENBMJ Global Health, Vol 5, Iss 12 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920 Infectious and parasitic diseases RC109-216
spellingShingle	Medicine (General) R5-920 Infectious and parasitic diseases RC109-216 Katherine Gambir Camille Garnsey Kelly Ann Necastro Thoai D Ngo Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19
description	Background 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.Methods 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.Results 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.Conclusion 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.PROSPERO registration number CRD42020183171.
format	article
author	Katherine Gambir Camille Garnsey Kelly Ann Necastro Thoai D Ngo
author_facet	Katherine Gambir Camille Garnsey Kelly Ann Necastro Thoai D Ngo
author_sort	Katherine Gambir
title	Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19
title_short	Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19
title_full	Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19
title_fullStr	Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19
title_full_unstemmed	Effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to COVID-19
title_sort	effectiveness, safety and acceptability of medical abortion at home versus in the clinic: a systematic review and meta-analysis in response to covid-19
publisher	BMJ Publishing Group
publishDate	2020
url	https://doaj.org/article/ce2e457fb78e40dd954f9c929db456c1
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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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