Skip to main content

Table 2 Summary of findings of efficacy, safety and satisfaction of different regimens of medical abortion

From: Medical termination for pregnancy in early first trimester (≤ 63 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review

Outcomes Risk Ration (RR) Confidence Interval (CI) Number of participants (Studies) GRADE
1. Combination mifepristone/misoprostol compared with misoprostolalone
A. Combination mifepristone-misoprostol compared with misoprostol alone (Table S1A)
 Efficacy: ongoing pregnancy RR 0.16 (0.08 to 0.31) 922 (3 RCTs) LOW
 Efficacy: success RR 1.23 (1.16 to 1.30) 922 (2 RCTs) VERY LOW
 Safety not estimable (1 RCT) VERY LOW
 Satisfaction RR 1.13 (1.00 to 1.26) 820 (2 RCTs) LOW
2. Comparisons of different regimens of misoprostol when combined with mifepristone
2.1. Comparison of misoprostol doses in combined regimen
A. Misoprostol buccal 400 μg compared with 800 μg in combined regimen (Table S2A)
 Efficacy: ongoing pregnancy RR 0.16 (0.08 to 0.31) 1115 (1 RCT) MODERATE
 Efficacy: success RR 1.23 (1.16 to 1.30) 1115 (1 RCT) MODERATE
 Safety RR 1.00 (0.02 to 50.76) 1115 (1 RCT) MODERATE
 Satisfaction RR 0.99 (0.97 to 1.02) 1106 (1 RCT) VERY LOW
B. Misoprostol oral 400 μg twice compared with 400 μg in combined regimen (Table S2B)
 Efficacy: ongoing pregnancy RR 0.10 (0.01 to 0.80) 297 (1 RCT) LOW
 Efficacy: success RR 1.03 (0.86 to 1.23) 297 (1 RCT) LOW
 Safety not estimable (0 studies)
 Satisfaction RR 1.03 (0.87 to 1.23) 293 (1 RCT) LOW
C. Misoprostol oral 800 μg single dose compared with 400 μg twice in combined regimen (Table S2C)
 Efficacy: ongoing pregnancy RR 0.88 (0.24 to 3.19) 637 (2 RCTs) MODERATE
 Efficacy: success RR 0.94 (0.89 to 0.99) 637 (2 RCTs) MODERATE
 Safety not estimable (0 studies)
 Satisfaction not estimable (0 studies)
D. Misoprostol sublingual 400 μg compared with 800 μg in combined regimen (Table S2D)
 Efficacy: ongoing pregnancy RR 3.44 (1.14 to 10.40) 1480 (1 RCT) MODERATE
 Efficacy: success RR 0.99 (0.92 to 1.07) 1480 (1 RCT) MODERATE
 Safety not estimable (0 studies)
 Satisfaction RR 0.99 (0.92 to 1.07) 1475 (1 RCT) LOW
E. Misoprostol vaginal 400 μg compared with 800 μg in combined regimen (Table S2E)
 Efficacy: ongoing pregnancy RR 2.23 (0.98 to 5.11) 1482 (1 RCT) MODERATE
 Efficacy: success RR 0.97 (0.90 to 1.05) 1482 (1 RCT) MODERATE
 Safety not estimable (0 studies)
 Satisfaction RR 0.99 (0.92 to 1.07) 1479 (1 RCT) LOW
F. Misoprostol oral 400 μg compared with 600 μg in combined regimen (Table S2F)
 Efficacy: ongoing pregnancy RR 0.33 (0.01 to 8.10) 638 (1 RCT) LOW
 Efficacy: success RR 1.01 (0.91 to 1.13) 638 (1 RCT) LOW
 Safety RR 0.33 (0.01 to 8.10) 638 (1 RCT) LOW
 Satisfaction RR 1.02 (0.91 to 1.16) 599 (1 RCT) LOW
2. 2. Comparison of dosing intervals between mifepristone and misoprostol in combined regimen
A. Misoprostol 800 μg vaginal given < 8 h compared with > 24 h after mifepristone (Table S3A)
 Efficacy: ongoing pregnancy RR 2.23 (0.69 to 7.20) 1525 (4 RCTs) MODERATE
 Efficacy: success RR 0.98 (0.91 to 1.06) 1525 (2 RCTs) MODERATE
 Safety RR 0.99 (0.02 to 49.60) 1100 (1 RCT) MODERATE
 Satisfaction RR 1.02 (0.87 to 1.18) 357 (1 RCT) LOW
B. Misoprostol 400–800 μg vaginal given 24 h compared with 48 h after mifepristone (Table S3B)
 Efficacy: ongoing pregnancy RR 0.92 (0.40 to 2.12) 3301 (3 RCTs) VERY LOW
 Efficacy: success RR 0.99 (0.80 to 1.23) 192 (3 RCTs) VERY LOW
 Safety not estimable (0 studies)
Satisfaction not estimable (0 studies)
C. Misoprostol 400 μg vaginal given concurrently compared with 24 h after mifepristone (Table S3C)
 Efficacy: ongoing pregnancy RR 0.98 (0.02 to 49.25) 258 (2 RCTs) VERY LOW
 Efficacy: success RR 1.01 (0.84 to 1.21) 280 (2 RCTs) VERY LOW
 Safety RR 1.00 (0.02 to 50.01) 178 (2 RCTs) VERY LOW
 Satisfaction RR 1.02 (0.74 to 1.39) 80 (1 RCT) VERY LOW
D. Misoprostol 400 μg oral given < 8 h compared with 48 h after mifepristone (Table S3D)
 Efficacy: ongoing pregnancy RR 8.34 (0.46 to 151.20) 100 (1 RCT) VERY LOW
 Efficacy: success RR 0.91 (0.66 to 1.25) 100 (1 RCT) VERY LOW
 Safety RR 1.96 (0.18 to 20.90) 100 (1 RCT) VERY LOW
 Satisfaction not estimable (0 studies)
3. Comparisons of misoprostol routes in combined mifepristone-misoprostol regimen
A. Misoprostol 400 μg sublingual compared with vaginal in combined regimen (Table S4A)
 Efficacy: ongoing pregnancy RR 0.79 (0.39 to 1.55) 1479 (1 RCT) MODERATE
 Efficacy: success RR 1.01 (0.94 to 1.09) 1479 (1 RCT) MODERATE
 Safety not estimable (0 studies)
 Satisfaction RR 1.00 (0.94 to 1.07) 1473 (1 RCT) MODERATE
B. Misoprostol 800 μg vaginal compared with sublingual in combined regimen (Table S4B)
 Efficacy: ongoing pregnancy RR 0.50 (0.15 to 1.67) 1483 (1 RCT) MODERATE
 Efficacy: success RR 0.99 (0.92 to 1.07) 1483 (1 RCT) MODERATE
 Safety not estimable (0 studies)
 Satisfaction RR 0.99 (0.92 to 1.07) 1481 (1 RCT) VERY LOW
C. Misoprostol 600/800 μg sublingual compared with 800 μg vaginal in combined regimen (Table S4C)
 Efficacy: ongoing pregnancy RR 0.15 (0.08 to 3.05) 346 (2 RCTs) LOW
 Efficacy: success RR 1.01 (0.87 to 1.18) 346 (2 RCTs) LOW
 Safety RR 1.00 (0.02 to 49.96) 224 (1 RCT) LOW
 Satisfaction not estimable (0 studies)
D. Misoprostol 800 μg oral compared with vaginal in combined regimen (Table S4D)
 Efficacy: ongoing pregnancy RR 6.70 (1.88 to 23.86) 1287 (3 RCTs) MODERATE
 Efficacy: success RR 0.94 (0.85 to 1.04) 1455 (3 RCTs) MODERATE
 Safety RR 0.35 (0.01 to 8.35) 263 (1 RCT) VERY LOW
 Satisfaction not estimable (0 studies)
E. Misoprostol 400 μg oral compared with 800 μg vaginal in combined regimen (Table S4E)
 Efficacy: ongoing pregnancy RR 2.38 (0.34 to 16.81) 1378 (2 RCTs) MODERATE
 Efficacy: success RR 0.98 (0.91 to 1.04) 2025 (2 RCTs) MODERATE
 Safety RR 0.33 (0.01 to 8.15) 637 (1 RCT) LOW
 Satisfaction RR 1.02 (0.91 to 1.16) 599 (1 RCT) LOW
F. Misoprostol 800 μg buccal compared with sublingual in combined regimen (Table S4F)
 Efficacy: ongoing pregnancy RR 0.98 (0.02 to 49.25) 90 (1 RCT) VERY LOW
 Efficacy: success RR 0.98 (0.73 to 1.33) 90 (1 RCT) VERY LOW
 Safety RR 0.98 (0.02 to 48.70) 178 (1 RCT) VERY LOW
 Satisfaction not estimable (0 studies)
G. Misoprostol 400 μg buccal compared with sublingual in combined regimen (Table S4G)
 Efficacy: ongoing pregnancy RR 1.55 (0.22 to 11.03) 539 (1 RCT) LOW
 Efficacy: success RR 0.98 (0.91 to 1.04) 539 (1 RCT) LOW
 Safety RR 0.33 (0.01 to 8.15) 539 (1 RCT) LOW
 Satisfaction RR 1.02 (0.91 to 1.16) 533 (1 RCT) LOW
H. Misoprostol 800 μg buccal compared with vaginal in combined regimen (Table S4H)
 Efficacy: ongoing pregnancy RR 0.49 (0.09 to 2.68) 429 (1 RCT) LOW
 Efficacy: success RR 1.00 (0.87 to 1.15) 429 (1 RCT) LOW
 Safety RR 2.94 (0.12 to 71.80) 429 (1 RCT) LOW
 Satisfaction RR 0.98 (0.85 to 1.13) 423 (1 RCT) LOW
I. Misoprostol 800 μg oral compared with buccal in combined regimen (Table S4I)
 Efficacy: ongoing pregnancy RR 3.61 (1.20 to 10.80) 847 (1 RCT) LOW
 Efficacy: success RR 0.97 (0.88 to 1.07) 847 (1 RCT) LOW
 Safety RR 0.33 (0.01 to 8.08) 847 (1 RCT) LOW
 Satisfaction RR 1.02 (0.91 to 1.12) 835 (1 RCT) LOW
J. Misoprostol 400 μg oral compared with sublingual in combined regimen (Table S4J)
 Efficacy: ongoing pregnancy RR 0.44 (0.10 to 1.96) 564 (2 RCTs) LOW
 Efficacy: success RR 1.03 (0.99 to 1.07 564 (2 RCTs) LOW
 Safety RR 0.98 (0.01 to 49.14) 471 (1 RCT) LOW
 Satisfaction RR 1.02 (0.89 to 1.18) 470 (1 RCT) LOW
4. Comparisons of different misoprostol only regimens
A. Misoprostol 400 μg oral every 3 h for 4 doses compared with 600 μg vaginal misoprostol once (Table S5A)
 Efficacy: ongoing pregnancy RR 1.50 (0.67 to 3.30) 76 (1 RCT) VERY LOW
 Efficacy: success RR 0.94 (0.52 to 1.70) 76 (1 RCT) VERY LOW
 Safety not estimable (0 studies)
 Satisfaction RR 0.9 (0.5 to 1.6) 76 (1 RCT) VERY LOW
B. Misoprostol 800 μg oral every 6 h for 2 doses compared with 600 μg vaginal misoprostol once (Table S5B)
 Efficacy: ongoing pregnancy RR 0.86 (0.28 to 2.59) 64 (1 RCT) VERY LOW
 Efficacy: success RR 1.12 (0.61 to 2.05) 64 (1 RCT) VERY LOW
 Safety not estimable (0 studies)
 Satisfaction RR 1.01 (0.54 to 1.88) 64 (1 RCT) VERY LOW
C. Misoprostol 400 μg oral every 3 h for 4 doses compared with 800 μg oral misoprostol every 6 h for 2 doses (Table S5C)
 Efficacy: ongoing pregnancy RR 1.75 (0.62 to 4.90) 60 (1 RCT) VERY LOW
 Efficacy: success RR 0.84 (0.44 to 1.59) 60 (1 RCT) VERY LOW
 Safety not estimable (0 studies)
 Satisfaction RR 0.89 (0.46 to 1.72) 60 (1 RCT) VERY LOW
5. Comparison of medical and surgical management- Medical management with 800 μg vaginal misoprostol compared with surgical management (Table S6)
 Efficacy: ongoing pregnancy RR 6.70 (1.88 to 23.86) 137 (1 RCT) VERY LOW
 Efficacy: success RR 1.02 (0.89 to 1.17) 137 (1 RCT) VERY LOW
 Safety RR 0.33 (0.01 to 8.04) 137 (1 RCT) VERY LOW
 Satisfaction not estimable (0 studies)