Effectiveness, safety and acceptability of self-assessment of the outcome of first-trimester medical abortion: a systematic review and meta-analysis.

Abstract

For many women, the need for multiple clinical visits is a barrier to medical abortion. We assessed the effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home versus routine clinic follow up after medical abortion. We searched databases such as MEDLINE, Embase, and CENTRAL to find studies published in 1991-2018. Eligible studies included women of reproductive age who had undergone a medical abortion that was completed at home. The intervention and self-assessment of the outcome of medical abortion done by urine pregnancy tests kits by women at home was compared with routine medical follow up at a clinic. Two researchers completed the study selection, data extraction, critical appraisal, and assessment of the evidence. The outcomes were successful complete abortions, side effects and complications, and acceptability. We performed meta-analyses when possible and GRADE to ascertain the certainty of the evidence. The protocol was registered in PROSPERO (CRD42017055316). Four randomised controlled trials (RCTs; n=5493) met our inclusion criteria. The pooled analysis from all studies showed no significant difference in complete abortion rates between self-assessment and routine clinic follow up: RR=1.00, 95% CI 0.99-1.01. The ongoing pregnancy rates were similar and the pooled results for the safety outcomes showed no significant differences between the groups. There was a significantly greater preference for self-assessment as the follow-up method. The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home are not inferior to routine clinic follow up. The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion are not inferior to routine clinic follow up.