TY - JOUR
T1 - Medical Abortion before Confirmed Intrauterine Pregnancy
T2 - A Systematic Review
AU - VEMA Study Group
AU - Brandell, Karin
AU - Reynolds-Wright, John J.
AU - Boerma, Clare
AU - Gibson, Gillian
AU - Hognert, Helena
AU - Tuladhar, Heera
AU - Heikinheimo, Oskari
AU - Cameron, Sharon
AU - Gemzell-Danielsson, Kristina
N1 - Publisher Copyright:
© 2022 Thieme Medical Publishers, Inc.. All rights reserved.
PY - 2023/1/10
Y1 - 2023/1/10
N2 - Very early medical abortion (VEMA) refers to medical abortion (with mifepristone and misoprostol) before intrauterine pregnancy is visualized on ultrasound. Our aim is to present the current evidence on efficacy, safety (focused on ectopic pregnancies), and how to assess treatment success of VEMA. We conducted a systematic review of studies reporting outcomes of VEMA. The field is small and so our objective was to map all relevant literature, without conducting meta-analysis. We searched PubMed, Medline, and Embase on April 19, 2022. We conducted a narrative synthesis of the evidence. A total of 373 articles were identified. Six articles (representing four observational and one pilot trial) were included in the final review. Across all included studies, treatment efficacy ranged between 91 and 100%. Prevalence of ectopic pregnancy was low and very few cases (n = 2) of ruptures were reported. Most studies used serial serum human chorionic gonadotrophin (s-hCG) levels to determine success of abortion; one study used low sensitivity urine hCG. From the available evidence, VEMA appears to be efficacious and does not appear to cause harm to ectopic pregnancies. Treatment can be assessed with pre- and postabortion s-hCG. Good quality, randomized controlled trial evidence is needed to best inform practice.
AB - Very early medical abortion (VEMA) refers to medical abortion (with mifepristone and misoprostol) before intrauterine pregnancy is visualized on ultrasound. Our aim is to present the current evidence on efficacy, safety (focused on ectopic pregnancies), and how to assess treatment success of VEMA. We conducted a systematic review of studies reporting outcomes of VEMA. The field is small and so our objective was to map all relevant literature, without conducting meta-analysis. We searched PubMed, Medline, and Embase on April 19, 2022. We conducted a narrative synthesis of the evidence. A total of 373 articles were identified. Six articles (representing four observational and one pilot trial) were included in the final review. Across all included studies, treatment efficacy ranged between 91 and 100%. Prevalence of ectopic pregnancy was low and very few cases (n = 2) of ruptures were reported. Most studies used serial serum human chorionic gonadotrophin (s-hCG) levels to determine success of abortion; one study used low sensitivity urine hCG. From the available evidence, VEMA appears to be efficacious and does not appear to cause harm to ectopic pregnancies. Treatment can be assessed with pre- and postabortion s-hCG. Good quality, randomized controlled trial evidence is needed to best inform practice.
KW - ectopic pregnancy
KW - medical abortion
KW - mifepristone
KW - misoprostol
KW - very early medical abortion
UR - http://www.scopus.com/inward/record.url?scp=85147536625&partnerID=8YFLogxK
U2 - 10.1055/s-0042-1760117
DO - 10.1055/s-0042-1760117
M3 - Review article
C2 - 36626915
AN - SCOPUS:85147536625
SN - 1526-8004
VL - 40
SP - 258
EP - 263
JO - Seminars in Reproductive Medicine
JF - Seminars in Reproductive Medicine
IS - 506
ER -