Abstract
BackgroundPrevious systematic reviews have concluded that medical termination of pregnancy (TOP) performed by non‐doctor providers may be as effective and safe as when provided by doctors. Medical treatment of incomplete miscarriage by non‐doctor providers and the treated women's acceptance of non‐doctor providers of TOP has not previously been reviewed.ObjectivesTo review the effectiveness, safety, and acceptability of first‐trimester medical TOP, including medical treatment for incomplete miscarriage, by trained non‐doctor providers.Search strategy and selection criteriaA search strategy using appropriate medical subject headings was developed. Electronic databases (PubMed, Popline, Cochrane, CINAHL, Embase, and ClinicalTrials.gov) were searched from inception through April 2016. Randomised controlled trials and comparative observational studies were included.Data collection and analysisMeta‐analyses were performed for included randomised controlled trials regarding the outcomes of effectiveness and acceptability to women. Certainty of evidence was established using the GRADE approach assessing study limitations, consistency of effect, imprecision, indirectness and publication bias.Main resultsSix papers were included. Medical TOP and medical treatment of incomplete miscarriage is probably equally effective when performed by non‐doctor providers as when performed by doctors (RR 1.00; 95% CI 0.99–1.01). Women's acceptance, reported as overall satisfaction with the allocated provider, is probably equally high between groups (RR 1.00; 95% CI 1.00–1.01).ConclusionMedical TOP and medical treatment of incomplete miscarriage provided by trained non‐doctor providers is probably equally as effective and acceptable to women as when provided by doctors.Tweetable abstractMedical termination of pregnancy performed by doctors and non‐doctors can be equally effective and acceptable
Highlights
Unsafe termination of pregnancy (TOP) is the cause of substantial maternal mortality and morbidity worldwide
The intervention was medical TOP or medical treatment of incomplete abortion provided by non-doctor providers [auxiliary nurse midwives (ANMs), nurses, midwives, nonconventional therapies doctors or associate clinicians]
ANMs and nurses,[21] one randomised controlled trials (RCTs) included nurse-midwives (NMWs),[25] and a third RCT included nurses,[24] all compared with doctors
Summary
Unsafe termination of pregnancy (TOP) is the cause of substantial maternal mortality and morbidity worldwide. The scarcity of healthcare providers is one of many recognised barriers to safe TOP.[3] Legal regulations limiting TOP provision to specialist doctors and a reluctance to provide TOP among potential healthcare providers because of stigma and fear of reprisals are among reasons that providers of TOP, and especially medical TOP, are limited in higher as well as lower resource settings, even where TOP is legal.[4,5,6] Women’s preference of providers influence their a 2017 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists Medical treatment of incomplete miscarriage by nondoctor providers and the treated women’s acceptance of nondoctor providers of TOP has not previously been reviewed
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