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Semin Reprod Med 2022; 40(05/06): 258-263
DOI: 10.1055/s-0042-1760117
Review Article

Medical Abortion before Confirmed Intrauterine Pregnancy: A Systematic Review

Karin Brandell   *
1   Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
2   Södertalje Hospital, Södertalje, Sweden
,
John J. Reynolds-Wright   *
3   MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
,
Clare Boerma
4   Family Planning NSW, Newington, Australia
,
Gillian Gibson
5   Womens Health, Auckland City Hospital, Auckland, New Zealand
,
Helena Hognert
6   Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Institution of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
,
Heera Tuladhar
7   KIST Medical College Teaching Hospital, Lalitpur, Nepal
,
Oskari Heikinheimo
8   Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
,
Sharon Cameron
9   NHS Lothian and University of Edinburgh, Edinburgh, United Kingdom
,
Kristina Gemzell-Danielsson
1   Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
10   Karolinska University Hospital, Stockholm, Sweden
,
On Behalf of the VEMA Study Group › Author Affiliations Funding K.G-D. received funding from the Swedish Research Council and K.B. received funding from European Society for Contraception and Reproductive Health for the clinical trial “VEMA –Very Early Medical Abortion Trial”. K.B. was supported by Region Stockholm (combined residency and PhD training program).
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Abstract

“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.

Keywords

medical abortion - mifepristone - misoprostol - very early medical abortion - ectopic pregnancy

* Equal contribution


Supplementary Material



Publication History

Article published online:
10 January 2023

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