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P035“No test” medication abortion: A systematic review

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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 Experts in the field were contacted for unpublished data and ongoing studies. 2,423 studies were reviewed using Colandr.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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