Abstract
Objective
We conducted a systematic review of the literature on the effectiveness of medical
abortion “reversal” treatment. Since the usual care for women seeking to continue
pregnancies after ingesting mifepristone is expectant management with fetal surveillance,
we also performed a systematic review of continuing pregnancy after mifepristone alone.
Study design
We searched PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus and the Cochrane Library for articles published through March 2015 reporting
the proportion of pregnancies continuing after treatment with either mifepristone
alone or after an additional treatment following mifepristone aimed at reversing its
effect.
Results
From 1115 articles retrieved, 1 study met inclusion criteria for abortion reversal,
and 13 studies met criteria for continuing pregnancy after mifepristone alone. The
one report of abortion reversal was a case series of 7 patients receiving varying
doses of progesterone in oil intramuscularly or micronized progesterone orally or
vaginally; 1 patient was lost to follow-up. The study was of poor quality and lacked
clear information on patient selection. Four of six women continued the pregnancy
to term [67%, 95% confidence interval (CI) 30–90%]. Assuming the lost patient aborted
resulted in a continuing pregnancy proportion of 57% (95% CI 25–84%). The proportion
of pregnancies continuing 1–2 weeks after mifepristone alone varied from 8% (95% CI
3–22%) to 46% (95% CI 37–56%). Continuing pregnancy was more common with lower mifepristone
doses and advanced gestational age.
Conclusions
In the rare case that a woman changes her mind after starting medical abortion, evidence
is insufficient to determine whether treatment with progesterone after mifepristone
results in a higher proportion of continuing pregnancies compared to expectant management.
Implications
Legislation requiring physicians to inform patients about abortion reversal transforms
an unproven therapy into law and represents legislative interference in the patient–physician
relationship.
Keywords
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Article info
Publication history
Published online: June 06, 2015
Accepted:
June 2,
2015
Received in revised form:
May 27,
2015
Received:
May 4,
2015
Footnotes
☆Conflicts of interest: none.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
