No-Test Medication Abortion

Medication abortion performed without prior pelvic examination or ultrasonogram is a safe and effective option for pregnancy termination. OBJECTIVE: To summarize the effectiveness and safety outcomes of medication abortion performed without prior pelvic examination or ultrasonogram (“no-test medication abortion”). DATA SOURCES: We searched the MEDLINE, Scopus, Web of Science, Cochrane (including ClinicalTrials.gov), CINAHL, Global Index Medicus, and CAB Direct databases to identify relevant studies published before April 2022 using a peer-reviewed search strategy including terms such as “medication abortion” and “ultrasonography.” We contacted experts in the field for unpublished data and ongoing studies. METHODS OF STUDY SELECTION: We reviewed 2,423 studies using Colandr. We included studies if they presented clinical outcomes of medication abortion performed with mifepristone and misoprostol and without prior pelvic examination or ultrasonogram. We excluded studies with duplicate data. We abstracted successful abortion rates overall, as well as rates by gestational age through 63 days, 70 days and past 84 days. We abstracted complication rates, including the need for surgical evacuation, additional medications, blood transfusion, and ectopic pregnancy. TABULATION, INTEGRATION AND RESULTS: We included 21 studies with a total of 10,693 patients with outcome data reported. The overall efficacy of no-test medication abortion was 96.4%; 93.8% (95% CI 92.8–94.6%) through 63 days of gestation and 95.2% (95% CI 94.7–95.7%) through 70 days of gestation. The overall rate of surgical evacuation was 4.4% (95% CI 4.0–4.9), need for additional misoprostol 2.2% (95% CI 1.8–2.6), blood transfusion 0.5% (95% CI 0.3–0.6), and ectopic pregnancy 0.06% (95% CI 0.02–0.15). CONCLUSION: Medication abortion performed without prior pelvic examination or ultrasonogram is a safe and effective option for pregnancy termination. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021240739.