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Objectives
To summarize the effectiveness and safety outcomes of medication abortion performed
without prior pelvic examination or ultrasound (“no test” medication abortion).
Methods
We searched Medline, Scopus, Web of Science, Cochrane, CINAHL, Global Index Medicus,
and CAB Direct databases to identify relevant studies prior to April 2022 using a
peer-reviewed search strategy including terms such as “medication abortion” and “ultrasonography.”
Experts in the field were contacted for unpublished data and ongoing studies. 2,423
studies were reviewed using Colandr. Studies were included if they presented clinical
outcomes of medication abortion performed without prior pelvic examination or ultrasound.
Studies with duplicate data were excluded. We abstracted successful abortion rates
overall, as well as rates by gestational age through 63 days, 70 days and past 84
days. We abstracted complication rates, including the need for surgical evacuation,
additional medications, blood transfusion, and ectopic pregnancy.
Results
We included 21 studies with a total of 10,693 patients with outcome data reported.
The overall efficacy of “no test” medication abortion was 96.4%, 93.8% through 63
days of gestation and 95.2% through 70 days of gestation. The overall rate of surgical
evacuation was 4.4%, need for additional misoprostol 2.2%, need for blood transfusion
was 0.5%, and ectopic pregnancy was 0.06%.
Conclusions
Medication abortion performed without prior pelvic examination or ultrasound is a
safe and effective option for pregnancy termination.
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Copyright
© 2022 Published by Elsevier Inc.
