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The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: a systematic review

      Abstract

      Objective

      We sought to evaluate the accuracy of assessing gestational age (GA) prior to first trimester medication abortion using last menstrual period (LMP) compared to ultrasound (U/S).

      Study Design

      We searched Medline, Embase and Cochrane databases through October 2013 for peer-reviewed articles comparing LMP to U/S for GA dating in abortion care. Two teams of investigators independently evaluated data using standard abstraction forms. The US Preventive Services Task Force and Quality Assessment of Diagnostic Accuracy Studies guidelines were used to assess quality.

      Results

      Of 318 articles identified, 5 met inclusion criteria. Three studies reported that 2.5–11.8% of women were eligible for medication abortion by LMP and ineligible by U/S. The number of women who underestimated GA using LMP compared to U/S ranged from 1.8 to 14.8%, with lower rates found when the sample was limited to a GA <63 days. Most women (90.5–99.1%) knew their LMP, 70.8–90.5% with certainty.

      Conclusion

      Our results support that LMP can be used to assess GA prior to medication abortion at GA <63 days. Further research looking at patient outcomes and identifying women eligible for medication abortion by LMP but ineligible by U/S is needed to confirm the safety and effectiveness of providing medication abortion using LMP alone to determine GA.

      Keywords

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      References

        • Sedgh G.
        • Singh S.
        • Shah I.H.
        • Ahman E.
        • Henshaw S.K.
        • Bankole A.
        Induced abortion: incidence and trends worldwide from 1995 to 2008.
        Lancet. 2012; 379: 625-632
      1. Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008.
        World Health Organization, Geneva2011
        • Singh S.
        • Wulf D.
        • Hussain R.
        • Bankole A.
        • Sedgh G.
        Abortion worldwide: a decade of uneven progress.
        Guttmacher Institute, New York2009
        • Clark W.
        • Panton T.
        • Hann L.
        • Gold M.
        Medication abortion employing routine sequential measurements of serum hCG and sonography only when indicated.
        Contraception. 2007; 75: 131-135
        • Clark W.
        • Bracken H.
        • Tanenhaus J.
        • Schweikert S.
        • Lichtenberg E.S.
        • Winikoff B.
        Alternatives to a routine follow-up visit for early medical abortion.
        Obstet Gynecol. 2010; 115: 264-272
        • Perriera L.K.
        • Reeves M.F.
        • Chen B.A.
        • Hohmann H.L.
        • Hayes J.
        • Creinin M.D.
        Feasibility of telephone follow-up after medical abortion.
        Contraception. 2010; 81: 143-149
        • Fiala C.
        • Safar P.
        • Bygdeman M.
        • Gemzell-Danielsson K.
        Verifying the effectiveness of medical abortion; ultrasound versus hCG testing.
        Eur J Obstet Gynecol Reprod Biol. 2003; 109: 190-195
        • Ngoc N.N.
        • Bracken H.
        • Blum J.
        • Nga N.T.
        • Minh N.H.
        • von Nhang N.
        • et al.
        Acceptability and feasibility of phone follow-up after early medical abortion in Vietnam.
        Obstet Gynecol. 2014; 23: 88-95
        • Cameron S.T.
        • Glasier A.
        • Dewart H.
        • Johnstone A.
        • Burnside A.
        Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation.
        Contraception. 2012; 86: 67-73
        • Schaff E.A.
        • Stadalius L.S.
        • Eisinger S.H.
        • Franks P.
        Vaginal misoprostol administered at home after mifepristone (RU486) for abortion.
        J Fam Pract. 1997; 44: 353-360
        • Elul B.
        • Hajri S.
        • Ngoc N.N.
        • Ellertson C.
        • Slama C.B.
        • Pearlman E.
        • et al.
        Can women in less-developed countries use a simplified medical abortion regimen?.
        Lancet. 2001; 357: 1402-1405
        • Guengant J.P.
        • Bangou J.
        • Elul B.
        • Ellertson C.
        Mifepristone-misoprostol medical abortion: home administration of misoprostol in Guadeloupe.
        Contraception. 1999; 60: 167-172
        • Kaneshiro B.
        • Edelman A.
        • Sneeringer R.K.
        • Ponce de Leon R.G.
        Expanding medical abortion: Can medical abortion be effectively provided without the routine use of ultrasound?.
        Contraception. 2011; 83: 194-201
        • Clark W.H.
        • Gold M.
        • Grossman D.
        • Winikoff B.
        Can mifepristone medical abortion be simplified? A review of the evidence and questions for future research.
        Contraception. 2007; 75: 245-250
        • Harris R.P.
        • Helfand M.
        • Woolf S.H.
        • Lohr K.N.
        • Mulrow C.D.
        • Teutsch S.M.
        • et al.
        Current methods of the US Preventive Services Task Force: a review of the process.
        Am J Prev Med. 2001; 20: 21-35
        • Whiting P.F.
        • Rutjes A.W.
        • Westwood M.E.
        • Mallett S.
        • Deeks J.J.
        • Reitsma J.B.
        • et al.
        QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.
        Ann Intern Med. 2011; 155: 529-536
        • Bracken H.
        • Clark W.
        • Lichtenberg E.S.
        • Schweikert S.M.
        • Tanenhaus J.
        • Barajas A.
        • et al.
        Alternatives to routine ultrasound for eligibility assessment prior to early termination of pregnancy with mifepristone-misoprostol.
        BJOG. 2011; 118: 17-23
        • Blanchard K.
        • Cooper D.
        • Dickson K.
        • Cullingworth L.
        • Mavimbela N.
        • von Mollendorf C.
        • et al.
        A comparison of women's, providers' and ultrasound assessments of pregnancy duration among termination of pregnancy clients in South Africa.
        BJOG. 2007; 114: 569-575
        • McGalliard C.
        • Gaudoin M.
        Routine ultrasound for pregnancy termination requests increases women's choice and reduces inappropriate treatments.
        BJOG. 2004; 111: 79-82
        • Harkness L.M.
        • Rodger M.
        • Baird D.T.
        Morphological and molecular characteristics of living human fetuses between Carnegie stages 7 and 23: ultrasound scanning and direct measurements.
        Hum Reprod Update. 1996; 3: 25-33
        • Harper C.
        • Ellertson C.
        • Winikoff B.
        Could American women use mifepristone-misoprostol pills safely with less medical supervision?.
        Contraception. 2002; 65: 133-142
        • Cooper D.
        • Dickson K.
        • Blanchard K.
        • Cullingworth L.
        • Mavimbela N.
        • von Mollendorf C.
        • et al.
        Medical abortion: the possibilities for introduction in the public sector in South Africa.
        Reprod Health Matters. 2005; 13: 35-43
        • Spitz I.M.
        • Bardin C.W.
        • Benton L.
        • Robbins A.
        Early pregnancy termination with mifepristone and misoprostol in the United States.
        N Engl J Med. 1998; 338: 1241-1247
        • Norman W.V.
        • Bergunder J.
        • Eccles L.
        Accuracy of gestational age estimated by menstrual dating in women seeking abortion beyond nine weeks.
        J Obstet Gynaecol Can. 2011; 33: 252-257
        • Ellertson C.
        • Elul B.
        • Winikoff B.
        Can women use medical abortion without medical supervision?.
        Reprod Health Matters. 1997; 5: 149-161
        • Ellertson C.
        • Elul B.
        • Ambardekar S.
        • Wood L.
        • Carroll J.
        • Coyaji K.
        Accuracy of assessment of pregnancy duration by women seeking early abortions.
        Lancet. 2000; 355: 877-881
        • Wegienka G.
        • Baird D.D.
        A comparison of recalled date of last menstrual period with prospectively recorded dates.
        J Womens Health. 2005; 14: 248-252
        • Winikoff B.
        • Dzuba I.G.
        • Chong E.
        • Goldberg A.B.
        • Lichtenberg E.S.
        • Ball C.
        • et al.
        Extending outpatient medical abortion services through 70 days of gestational age.
        Obstet Gynecol. 2012; 120: 1070-1076
        • Gouk E.V.
        • Lincoln K.
        • Khair A.
        • Haslock J.
        • Knight J.
        • Cruickshank D.J.
        Medical termination of pregnancy at 63 to 83 days gestation.
        Br J Obstet Gynaecol. 1999; 106: 535-539
        • Centers for Disease C
        Prevention.
        in: Ectopic pregnancy--United States, 1990-1992. MMWR Morbidity and mortality weekly report. 44(3). 1995: 46-48
        • Van Den Eeden S.K.
        • Shan J.
        • Bruce C.
        • Glasser M.
        Ectopic pregnancy rate and treatment utilization in a large managed care organization.
        Obstet Gynecol. 2005; 105: 1052-1057
        • Hoover K.W.
        • Tao G.
        • Kent C.K.
        Trends in the diagnosis and treatment of ectopic pregnancy in the United States.
        Obstet Gynecol. 2010; 115: 495-502
        • Stulberg D.B.
        • Cain L.R.
        • Dahlquist I.
        • Lauderdale D.S.
        Ectopic pregnancy rates in the Medicaid population.
        Am J Obstet Gynecol. 2013; 208: 274.e1-274.e7
        • Barnhart K.T.
        • Simhan H.
        • Kamelle S.A.
        Diagnostic accuracy of ultrasound above and below the beta-hCG discriminatory zone.
        Obstet Gynecol. 1999; 94: 583-587
        • Mol B.W.
        • van der Veen F.
        • Bossuyt P.M.
        Symptom-free women at increased risk of ectopic pregnancy: should we screen?.
        Acta Obstet Gynecol Scand. 2002; 81: 661-672
        • Goldstein S.R.
        • Wolfson R.
        Endovaginal ultrasonographic measurement of early embryonic size as a means of assessing gestational age.
        J Ultrasound Med. 1994; 13: 27-31