Abstract
Background
The provision of safe abortion services to women who need them has the potential to
drastically reduce or eliminate maternal deaths due to unsafe abortion. The World
Health Organization recently updated its evidence-based guidance for safe and effective
clinical practices using data from systematic reviews of the literature.
Materials and Methods
Systematic reviews pertaining to the evidence for safe abortion services, from pre-abortion
care, medical and surgical methods of abortion and post-abortion care were evaluated
for relevant outcomes, primarily those relating to safety, effectiveness and women's
preference.
Results
Sixteen systematic reviews were identified and evaluated. The available evidence does
not support the use of pre-abortion ultrasound to increase safety. Routine use of
cervical preparation with osmotic dilators, mifepristone or misoprostol after 14 weeks
gestation reduces complications; at early gestational ages, surgical abortions have
very few complications. Prophylactic antibiotics result in lower rates of post-surgical
abortion infection. Pain medication such as non-steroidal anti-inflammatories should
be offered to women undergoing abortion procedures; acetaminophen, however, is not
effective in reducing pain. Women who are eligible should be offered a choice between
surgical (vacuum aspiration or dilation and evacuation) and medical methods (mifepristone
and misoprostol) of abortion when possible. Modern methods of contraception can be
safely initiated immediately following abortion procedures.
Conclusions
Evidence-based guidelines assist health care providers and policymakers to utilize
the best data available to provide safe abortion care and prevent the millions of
deaths and disabilities that result from unsafe abortion.
Keywords
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References
- Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008.6th ed. World Health Organization, Geneva (Switzerland)2011
- Safe abortion: technical and policy guidance for health systems.World Health Organization, Geneva2003
- Appraising systematic reviews and meta-analyses.Arch Dermatol. 2003; 139: 795-798
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.Br Med J. 2008; 336: 924-926
- The use of first trimester ultrasound.J Obstet Gynaecol Can. 2003; 25: 864-875
- Comprehensive analysis of the use of pre-procedure ultrasound for first- and second-trimester abortion.Contraception. 2010; 83: 30-33
- Comparing bimanual pelvic examination to ultrasound measurement for assessment of gestational age in the first trimester of pregnancy.J Reprod Med. 2012; 47: 825-828
- The value of real-time ultrasonography in first trimester termination.Contraception. 1986; 33: 533-538
- Complications of first-trimester abortion: a report of 170,000 cases.Obstet Gynecol. 1990; 76: 129-135
- Ectopic pregnancy concurrent with induced abortion: incidence and mortality.Am J Obstet Gynecol. 1990; 162: 726-730
- An updated protocol for abortion surveillance with ultrasound and immediate pathology.Obstet Gynecol. 1994; 83: 55-58
- New technologies permit safe abortion at less than six weeks' gestation and provide timely detection of ectopic gestation.Am J Obstet Gynecol. 1997; 176: 1101-1106
- Early abortion in family medicine: clinical outcomes.Ann Fam Med. 2009; 7: 527-533
- Board of Society for Family Planning. Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation). SFP Guideline 20071.Contraception. 2007; 76: 139-156
- Cervical preparation for first trimester surgical abortion.Cochrane Database Syst Rev. 2010; (Issue 2. Art. No.: CD007207)https://doi.org/10.1002/14651858.CD007207.pub2
- Nitric oxide donors for cervical ripening in first-trimester surgical abortion.Cochrane Database Syst Rev. 2009; : CD007444
- Cervical preparation with misoprostol before first trimester induced vacuum aspiration abortion reduces complications: a multicentre randomized clinical trial.Lancet. 2012; 379: 1817-1824
- Cervical preparation for second trimester dilation and evacuation.Cochrane Database Syst Rev. 2010; 8: CD007310
- Second-trimester abortion by dilatation and evacuation: an analysis of 11,747 cases.Obstet Gynecol. 1983; 62: 185-190
- Incidence of bacteremia at dilation and curettage.J Reprod Med. 1992; 37: 331-334
- Complications of first-trimester abortion: a report of 170,000 cases.Obstet Gynecol. 1990; 76: 1145-1146
- Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102.Contraception. 2011; 83: 295-309
- Postabortal endometritis and isolation of chlamydia trachomatis.Obstet Gynecol. 1986; 68: 686-690
- Untreated endocervical gonorrhea and endometritis following elective abortion.Am J Obstet Gynecol. 1976; 126: 648-651
- Postabortal pelvic sepsis in association with Chlamydia trachomatis.Aust N Z J Obstet Gynaecol. 1990; 30: 347-350
- Perioperative antibioitics to prevent infection after first-trimester abortion.Cochrane Database Syst Rev. 2012; (Issue 3. Art. No.: CD005217)https://doi.org/10.1002/14651858.CD005217.pub2
- Rates of serious infection after changes in regimens for medical abortion.NEJM. 2009; 361: 145-151
- Pain of first-trimester abortion: a study of psychosocial and medical predictors.Pain. 1989; 36: 339-350
- Comparison of paracervical block techniques during first trimester pregnancy termination.Int J Obstet Gynecol. 2001; 72: 171-178
- Analgesia requirements and predictors of analgesia use for women undergoing medical abortion up to 22 weeks of gestation.BJOG. 2004; 111: 996-1000
- Early pregnancy termination with mifepristone and misoprostol in the United States.NEJM. 1998; 338: 1241-1247
- Pain during early abortion.J Reprod Med. 1997; 42: 287-293
- Control of Pain for Women Undergoing Abortion.Int Gynecol. 1989; : 131-140
- Pain control in first trimester surgical abortion.Cochrane Database Syst Rev. 2009; (Issue 2. Art. No.: CD006712)https://doi.org/10.1002/14651858.CD006712.pub2
- Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review.Contraception. 2011; 83: 116-126
- Risk factors for legal induced abortion-related mortality in the United States.Obstet Gynecol. 2004; 103: 729-737
- Complications from legally-induced abortion: a review.Obstet Gynecol Survey. 1979; 34: 177-191
- The safety of deep sedation without intubation for abortion in the outpatient setting.Clin Anesth. 2011; 23: 437-442
- Medical versus surgical methods for first trimester termination of pregnancy.Cochrane Database Syst Rev. 2005; : CD003037
- Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews.Cochrane Database Syst Rev. 2011; : CD002855
- Surgical versus medical methods for second trimester induced abortion.Cochrane Database Syst Rev. 2008; : CD006714
- Labor induction abortion in the second trimester. SFP Guideline 2011.Contraception. 2011; 84: 4-18
- Medical methods for mid-trimester termination of pregnancy.Cochrane Database Syst Rev. 2010; (Issue 1. Art. No.: CD005216)https://doi.org/10.1002/14651858.CD005216.pub2
- Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review.Obstet Gynecol. 2009; 113: 1117-1123
- Routine follow-up visits after first-trimester induced abortion.Obstet Gynecol. 2004; 103: 738-745
- Alternatives to ultrasound for follow-up after medication abortion: a systematic review.Contraception. 2011; 83: 504-510
- Can women accurately assess the outcome of medical abortion based on symptoms alone?.Contraception. 2012; 85: 192-197
- Use of combined oral contraceptives post abortion.Contraception. 2009; 80: 355-362
- Immediate postabortal insertion of intrauterine devices.Cochrane Database Syst Rev. 2010; (Issue 6. Art. No.: CD001777)https://doi.org/10.1002/14651858.CD001777.pub3
- Medical eligibility criteria for contraceptive use.4th ed. World Health Organization, Geneva2009 (http://whqlibdoc.who.int/publications/2010/9789241563888_eng.pdf)
- Medical treatments for incomplete miscarriage (less than 24 weeks).Cochrane Database Syst Rev. 2010;
- Surgical procedures to evacuate incomplete miscarriage.Cochrane Database Syst Rev. 2010; : CD001993https://doi.org/10.1002/14651858
Article info
Publication history
Published online: December 20, 2012
Accepted:
October 22,
2012
Received in revised form:
September 4,
2012
Received:
March 13,
2012
Footnotes
☆The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the World Health Organization or Ipas.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
