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