The efficacy of medical abortion: A meta-analysis

James G. Kahn, Betsy Jane Becker, Laura MacIsaa, John K. Amory, John Neuhaus, Ingram Olkin, Mitchell D Creinin

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Multiple clinical studies demonstrate the efficacy of medical abortion with mifepristone or methotrexate followed by a prostaglandin analogue. However, assessing predictors of success, including regimen, is difficult because of regimen variability and a lack of direct comparisons. This meta-analysis estimates rates of primary clinical outcomes of medical abortion (successful abortion, incomplete abortion, and viable pregnancy) and compares them by regimen and gestational age. We identified 54 studies published from 1991 to 1998 using mifepristone with misoprostol (18), mifepristone with other prostaglandin analogues (23), and methotrexate with misoprostol (13). Data abstracted from studies included regimen details and clinical outcomes by gestational age. We found that efficacy decreases with increasing gestational age (p <0.001), and differences by regimen are not statistically significant except at gestational age ≥57 days. For gestations ≤49 days, mean rates of complete abortion were 94-96%, incomplete abortion 2-4%, and ongoing (viable) pregnancy 1-3%. For gestations of 50-56 days, the mean rate of complete abortion was 91% (same for all regimens), incomplete abortion 5-8%, and ongoing pregnancy 3-5%. For ≥57 days, success was lower for mifepristone/misoprostol (85%, 95% confidence interval 78-91%) than for mifepristone/other prostaglandin analogues 95% (CI 91-98%, p = 0.006). For mifepristone/misoprostol, using ≥2 prostaglandin analogue doses seems to be better than a single dose for certain outcomes and gestational ages. We conclude that both mifepristone and methotrexate, when administered with misoprostol, have high levels of success at ≤49 days gestation but may have lower efficacy at longer gestation. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)29-40
Number of pages12
JournalContraception
Volume61
Issue number1
DOIs
StatePublished - Jan 2000
Externally publishedYes

Fingerprint

Mifepristone
Misoprostol
Meta-Analysis
Synthetic Prostaglandins
Incomplete Abortion
Gestational Age
Pregnancy
Methotrexate
Induced Abortion
Confidence Intervals

Keywords

  • Abortion
  • Medical abortion
  • Meta-analysis
  • Methotrexate
  • Mifepristone

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Kahn, J. G., Becker, B. J., MacIsaa, L., Amory, J. K., Neuhaus, J., Olkin, I., & Creinin, M. D. (2000). The efficacy of medical abortion: A meta-analysis. Contraception, 61(1), 29-40. https://doi.org/10.1016/S0010-7824(99)00115-8

The efficacy of medical abortion : A meta-analysis. / Kahn, James G.; Becker, Betsy Jane; MacIsaa, Laura; Amory, John K.; Neuhaus, John; Olkin, Ingram; Creinin, Mitchell D.

In: Contraception, Vol. 61, No. 1, 01.2000, p. 29-40.

Research output: Contribution to journalArticle

Kahn, JG, Becker, BJ, MacIsaa, L, Amory, JK, Neuhaus, J, Olkin, I & Creinin, MD 2000, 'The efficacy of medical abortion: A meta-analysis', Contraception, vol. 61, no. 1, pp. 29-40. https://doi.org/10.1016/S0010-7824(99)00115-8
Kahn JG, Becker BJ, MacIsaa L, Amory JK, Neuhaus J, Olkin I et al. The efficacy of medical abortion: A meta-analysis. Contraception. 2000 Jan;61(1):29-40. https://doi.org/10.1016/S0010-7824(99)00115-8
Kahn, James G. ; Becker, Betsy Jane ; MacIsaa, Laura ; Amory, John K. ; Neuhaus, John ; Olkin, Ingram ; Creinin, Mitchell D. / The efficacy of medical abortion : A meta-analysis. In: Contraception. 2000 ; Vol. 61, No. 1. pp. 29-40.
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