Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review
Thoai D Ngo, Min Hae Park, Haleema Shakur & Caroline Free
Volume 89, Number 5, May 2011, 360-370
Table 2. Studies comparing home-based and clinic-based medical abortion included in systematic review
| Study | Mifepristone dose (mg); misoprostol dose (µg), [supplementary dose]; routea | No. of women recruited (no. lost to follow up) |
Complete abortion, no. (%) |
Complete abortion, OR (95% CI)b | Maximum gestational age (days) | Contact with health services | Women accompanied during home administration of misoprostol (%) | Comparative participant characteristics at baseline | |||
|---|---|---|---|---|---|---|---|---|---|---|---|
| H | C | H | C | ||||||||
| Akin et al. 2004, |
200; 400; oral | 104 (4) | 104 (3) | 92 (88.5) | 83 (79.8) | 1.94 (0.90–4.18) | 56 | 11.5% of clinic users vs 3.8% of home users made unscheduled clinic visits (P < 0.04) | 55 | No difference in age, education, marital status (married: n = 98 home; n = 96 clinic), gestational age, gravidity or abortion history | |
| Bracken et al. 2006, |
200; 400; oral | 361; 6 | 48 (1) | 345 (97.2) | 46 (97.9) | 0.94 (0.21–4.21) | 56 | 4.2% of women made unscheduled clinic visits, no difference between groups; 27.1% called hotline, no difference between groups | 67.8 | No difference in age, education, marital status (married: n = 260 home; n = 36 clinic), gestational age, gravidity or abortion history | |
| Bracken et al. 2010, |
200; 400; oral | 530 (21) | 69 (3) | 453 (85.5) | 61 (88.41) | 0.77 (0.36–1.68) | 56 | Not reported | 84.2 | No difference in gestational age, gravidity or abortion history. Home users were 1.6 y older than clinic users on average (P = 0.008); marital status not reported | |
| Dagousset et al. 2004, |
600; 400 [400]; oral | 120 (0) | 289 (0) | 114 (95) | 286 (99)* | 0.20 (0.05–0.81) | 49 | 21.7% of home users called gynaecologist | All women (inclusion criterion) | Home users were older and more educated and fewer of them were primigravida; marital status not reported | |
| Elul et al. 2001, |
200; 400; oral | 106 (8) | 14 (0) | 102 (96) | 11 (80) | 6.96 (1.38–35.18) | 56 | 27% of clinic users vs 31% of home users made unscheduled clinic visits; 7% of clinic users vs 8% of home users called the clinic | 78 | No comparison reported; marital status not reported | |
| Elul et al. 2001, |
200; 400; oral | 170 (4) | 25 (0) | 158 (93) | 22 (88) | 1.80 (0.47– 6.87) | 56 | 18% of clinic users vs 8% of home users made unscheduled clinic visits; 24% of clinic users vs 18% of home users called the clinic | 76 | No comparison reported; marital status not reported | |
| Hajri et al. 2004, |
200; 400; oral | 241 (9) | 82 (0) | 233 (96.7) | 76 (92.7) | 2.30 (0.77–6.84) | 56 | 12.3% of clinic users vs 5.4% of home users made unscheduled clinic visits; 18.5% of clinic users vs 14.6% of home users called study hotline | ~75 | No difference in age, marital status (married: n = 193 home; n = 193 clinic), gestational age, parity or abortion history. Home users were more educated than clinic users by an average of 1.4 y (P = 0.02) | |
| Karki et al. 2009, |
200; 400; oral | 323 (31) | 77 (2) | 267 (91.4) | 68 (90.7) | 0.63 (0.30–1.34) | 56 | 16.9% of clinic users vs 11.1% of home users made unscheduled clinic visits; 20.8% of clinic users vs 19.5% of home userscalled the clinic hotline | 77.9 | Similar in age, education, gestational age and abortion history (no statistical test reported); marital status not reported | |
| Ngoc et al. 2004, |
200; 400; oral | 1380 (24) | 174 (0) | 1231 (88.6) | 164 (94.3)* | 0.50 (0.26–0.98) | 56 | 4.6% of clinic users vs 9.0% of home users made unscheduled clinic visits (P = 0.047); 6.9% of clinic users vs 15.5% of home users called hotline (P = 0.002) | 73.4 | No difference in age, marital status (married: n = 1 244 home; n = 158 clinic) and abortion history. Home users were more educated (< 0.001), had lower maximum gestational age (0.001) and higher gravidity (< 0.001), and fewer of them were primigravida (0.001) | |
| Provansal et al. 2009, |
600; 400 [400]; oral | 143 (30) | 162 (64) | 124 (86.7) | 155 (95.8)* | 0.30 (0.12– 0.72) | 49 | Not reported | All women (inclusion criterion) | No difference in abortion history. Home users were older (P < 0.001) and had higher gravidity (< 0.001) and higher parity (P < 0.001); fewer of them were primigravida (< 0.01). Marital status not reported | |
| Total | 3478 | 1044 | 3119 (89.7) | 972 (93.1) | – | – | – | – | – | ||
C, clinic; CI, confidence interval; H, home; OR, odds ratio; *P < 0.05.
a Delay to misoprostol is 48 hours except in Provansal et al. (36–48 hours) and Dagousset et al. (unspecified); supplementary dose of misoprostol administered to women in clinic-based groups if no expulsion of product within 3 hours of first misoprostol dose.
b Odds ratio: odds of complete abortion without surgery in women who used home-based relative to the odds in women who underwent clinic-based abortion.