Comparison of Clinical Outcomes between Medical Abortion and Surgical Abortion: Systematic Review and Meta-analysis

Abstract

According to the recent legal changes concerning abortion in Korea, clinical pharmacists are required to improve their evidence-based knowledge of medical abortion using mifepristone and misoprostol. This systemic review and meta-analysis compared clinical outcomes between medical and surgical abortion methods at the first trimester of pregnancy using acceptability and satisfaction, as well as methods that are currently available worldwide. PubMed, KMbase and KISS databases were utilized for literature searches, and randomized controlled studies reporting complete abortion as a primary endpoint were analyzed. The program Review Manager version 5.4 (Cochrane Collaboration) was employed to estimate the pooled risk ratio (RR) with 95% confidence interval (CI); random effect models were applied for all analyses. A total of 1,093 studies were identified, nine of which were eligible and selected for a meta-analysis. The pooled complete abortion rate was higher for surgical abortion than for medical abortion (RR 1.07, 95% CI 1.04-1.09). As a complication of intervention, bleeding (RR 3.29, 95% CI 2.21-4.91), nausea (RR 2.82, 95% CI 2.26-3.51), vomiting (RR 5.71, 95% CI 3.60-9.06), pain (RR 1.61, 95% CI 1.18-2.20) and fever (RR 2.36, 95% CI 0.97-5.75) all scored higher for medical abortion than for surgical abortion. However, acceptability (RR 1.25, 95% CI 1.12-1.40) and satisfaction (RR 1.60, 95% CI 1.34-1.89) scored higher for medical abortion than for surgical abortion. While medical abortion showed statistically significant weakness compared with surgical abortion with regard to complete abortion and complications, personal preferences could be better for medical abortion due to surgical intervention related fears. This study could significantly help women who prefer abortion in decision making as well as pharmacists in providing professional services regarding miscarriage medicines in clinical settings.