S.No | Author, year | Methods | Setting | Participants | Interventions |
---|---|---|---|---|---|
1. | Blanchard et al. 2005 [14] | Randomized controlled trial | KEM Hospital in Pune, India, and Hungvuong Hospital in Ho Chi Minh City, Vietnam. | Women seeking pregnancy termination at 56 days or less of amenorrhea. All eligible women had a transvaginal ultrasound scan to confirm duration of pregnancy. | Misoprostol oral 400 μg every 3 h for 4 doses (N = 36) vs. Misoprostol oral 800 μg every 6 h for 2 doses (N = 24) vs. Misoprostol vaginal 600 μg for 1 dose (N = 40) |
2. | Blum et al. 2012 [6] | Randomized controlled trial | Two large maternity hospitals: the Centre de Maternite et Neonatologie de la Rabta in Tunisia (n = 193) and Hung Vuong Hospital, Ho Chi Minh City, Vietnam (n = 248). | Pregnant women presenting for early medical abortion up to 63 days since their last menstrual period. | Mifepristone + misoprostol combined Mifepristone 200 mg on day 1 and 800 μg buccal misoprostol followed by placebo 3 h later on day 2 (N = 220) vs. Misoprostol alone Placebo on day 1 and 1600 μg of misoprostol (2 doses of 800 μg, given 3 h apart) on day 2 (N = 221) |
3. | Chai et al. 2013 [18] | Randomized controlled trial | Conducted at the Family Planning Association in Hong Kong. | Healthy women aged 18 years or older who requested termination of pregnancy of up to 63 days’ gestation. A transvaginal ultrasound examination was performed to verify the duration of pregnancy and to determine the gestational age. | Misoprostol buccal Misoprostol buccal 800 μg (four 200 μg misoprostol buccal and four sublingual placebo) 48 h after receiving mifepristone (N = 45) vs. Misoprostol sublingual Misoprostol sublingual 800 μg (four 200 μg misoprostol sublingual and four buccal placebo) 48 h after receiving mifepristone (N = 45) |
4. | Chawdhary et al. 2009 [19] | Randomized controlled trial | Department of Obstetrics and Gynecology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. | Trans vaginal ultrasound demonstrating an intact single intrauterine pregnancy up to a 63-day period of gestation. | Mifepristone + misoprostol combined Mifepristone 200 mg on day 1 and vaginal misoprostol 800 μg on day 3 (N = 50) vs. Misoprostol alone Misoprostol vaginal (800 μg) on day 1 and 3 (total dose 1600 μg) (N = 50) |
5. | Chong et al. 2012 [9] | Randomized controlled trial | Three clinics in the Republic of Georgia and at Hoc Mon Hospital in Vietnam. | Women who presented for termination of pregnancy with gestations up to 63 days since last menstrual period (LMP). | Misoprostol buccal 400 μg Misoprostol buccal 400 μg (two 200 μg misoprostol and two placebo pills) 36–48 h after mifepristone (N = 559) vs. Misoprostol buccal 800 μg Misoprostol buccal 800 μg (four 200 μg misoprostol pills) 36–48 h after mifepristone (N = 563) |
6. | Coyaji et al. 2007 [20] | Randomized controlled trial | K.E.M. Hospital in Pune (n = 150) and the Health Centre, Larsen and Toubro Limited, Mumbai, India (n = 150). | Women seeking termination of pregnancies could participate if they had amenorrhoea of 8 weeks or less. | Two doses of misoprostol Two doses of 400 μg oral misoprostol taken in 3 h interval 48 h after mifepristone (N = 150) vs. Single dose of misoprostol Single dose of 400 μg oral misoprostol and 2 placebo tablets 3 h later 48 h after mifepristone (N = 150) |
7. | Creinin et al. 2007 [12] | Randomized controlled trial | Four centers: The University of Pittsburgh, Oregon Health and Science University, Northwestern University, and the University of Southern California. The University of Pittsburgh served as the sponsoring institution. | Healthy women requesting an elective abortion, had an intrauterine pregnancy less than or equal to 63 days of gestation on the day of mifepristone administration as confirmed by vaginal ultrasound. | Misoprostol 800 μg vaginal immediately after taking mifepristone (N = 567) vs. Misoprostol 800 μg vaginal misoprostol 24 h after taking mifepristone (N = 561) |
8. | Dahiya et al. 2011 [21] | Randomized controlled trial | Postpartum center at PGIMS Rohtak, India. | Healthy women with intrauterine pregnancy < 56 days based on menstrual history and clinical examination. | Misoprostol oral 400 μg 24 h after mifepristone (N = 48) vs. Misoprostol sublingual 400 μg 24 h after mifepristone (N = 45) |
9. | Dahiya et al. 2012 [7] | Randomized controlled trial | Outpatient department of Obstetrics and Gynecology of Pt BDSharma PGIMS, Rohtak, India. | Women with amenorrhea < 56 days, age > 18 years, request for elective abortion with the indication as per the guidelines of the 1971 MTP act. | Mifepristone + misoprostol combined Mifepristone 200 mg oral and 800 μg buccal misoprostol after 24 h (N = 50) vs. Misoprostol alone Misoprostol buccal 800 μg (N = 50) |
10. | El-Refaey et al. 1994 [22] | Randomized controlled trial | Department of Obstetrics and Gynaecology, University of Aberdeen | Women requesting termination of pregnancy of less than 56 days amenorrhea confirmed by ultrasound scan examination and fulfilling the criteria of the 1967 Abortion Act. | Misoprostol oral 800 μg single dose 36–48 h after mifepristone (N = 75) vs. Misoprostol oral 400 μg repeated 2 h later 36–48 h after mifepristone (N = 75) |
11. | El-Refaey et al. 1995 [23] | Randomized controlled trial | Fertility-control clinic, Aberdeen Royal Hospitals, Aberdeen, Scotland. | Women requesting termination of pregnancy within 63 days from the onset of amenorrhea and fulfilling the criteria of the 1967 Abortion Act. | Misoprostol oral 800 μg 36–48 h after mifepristone (N = 130) vs. Misoprostol vaginal 800 μg 36–48 h after mifepristone (N = 133) |
12. | Fekih et al. 2010 [24] | Randomized controlled trial | Department of Obstetrics and Gynecology in Farhat Hached Teaching Hospital, Sousse, Tunisia. | Women requesting 1st trimester abortion of less than or equal to 56 days from their last menstrual period, determined by vaginal probe ultrasound and a maximum embryonic length of 17 mm. | Mifepristone + misoprostol combined Mifepristone 200 mg followed by 400 μg of oral misoprostol after 48 h (N = 126) vs. Misoprostol alone Misoprostol sublingual 800 μg (repeated every 4 h for up to a maximum of 3 doses) (N = 126) |
13. | Goel et al. 2011 [25] | Randomized controlled trial | Obstetrics and Gynaecology Department, MMIMSR, Mullana (Ambala), Haryana, India. | Healthy pregnant women, who were requesting an elective abortion and had a single intrauterine pregnancy of < 7 weeks (49 days) of gestation as confirmed by transvaginal ultrasonography. | Misoprostol vaginal 400 μg simultaneously with mifepristone (N = 40) vs. Misoprostol vaginal 400 μg 24 h after mifepristone (N = 40) |
14. | Guest et al. 2007 [11] | Randomized controlled trial | Ninewells Hospital, Dundee, Scotland. | An intrauterine pregnancy confirmed on pelvic ultrasound scan, gestation not exceeding 63 days at the administration of mifepristone and participants must be aged 16 years or older, seeking a termination of pregnancy. | Misoprostol vaginal 800 μg after 6 h of mifepristone (N = 225) vs. Misoprostol vaginal 800 μg after 36–48 h of mifepristone (N = 225) |
15. | Hamoda et al. 2005 [26] | Randomized controlled trial | Aberdeen Royal Infirmary, United Kingdom. | Women with a viable singleton intrauterine pregnancy (confirmed by transvaginal ultrasound scan) requesting medical abortion up to 13 weeks of gestation. Data aggregated by gestational age. | Misoprostol sublingual 600 μg followed 3 h later by a further dose of 400 μg sublingual misoprostol (N = 57) vs. Misoprostol vaginal 800 μg followed 3 h later by a further dose of 400 μg vaginal misoprostol (N = 72) |
16. | Jain et al. 2002 [27] | Randomized controlled trial | Women’s and Children’s Hospital and affiliated clinics, Los Angeles County-University of Southern California Medical Center and San Francisco General Hospital, University of California, San Francisco, United States. | A total of 250 healthy women desiring termination of pregnancies < 56 days gestation were enrolled. | Mifepristone + misoprostol combined Mifepristone 200 mg followed after 48 h by 800 μg of vaginal misoprostol (repeated every 24 h for up to a maximum of 3 doses) (N = 125) vs. Misoprostol alone Placebo on day 1 and misoprostol vaginal 800 μg repeated every 24 h for up to a maximum of 3 doses (N = 125) |
17. | Middleton et al. 2005 [28] | Randomized controlled trial | Two sites in Rochester, NY, United States. | Women seeking abortion with pregnancies through 56 days LMP. | Misoprostol buccal 800 μg 1–2 days after mifepristone (N = 223) vs. Misoprostol vaginal 800 μg 1–2 days after mifepristone (N = 219) |
18. | Ngoc et al. 2011 [8] | Randomized controlled trial | Tertiary hospital in Ho Chi Minh City, Vietnam. | Women with gestational age up to 63 days by LMP, living and working within an hour from the hospital desiring medical abortion. | Mifepristone + misoprostol combined Mifepristone 200 mg followed 24 h later by 800 μg buccal misoprostol followed by placebo 24 h later after misoprostol (N = 202) vs. Misoprostol alone Placebo followed by 800 μg buccal misoprostol repeated 24 and 48 h later (1600 μg total) (N = 198) |
19. | Prasad et al. 2009 [29] | Randomized controlled trial | Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India. | Women with gestational age up to 49 days confirmed by clinical examination and pelvic ultrasound seeking abortion. | Medical abortion-misoprostol vaginal 800 μg (N = 70) vs. Surgical intervention (N = 70) |
20. | Raghavan et al. 2009 [30] | Randomized controlled trial | University Clinic, Municipal Clinical Hospital No.1, Chisinau, the Republic of Moldova. | The date of onset of last menses plus pelvic examination were used to calculate gestational age, with ultrasound confirmation as needed. | Misoprostol sublingual 400 μg 24 h after mifepristone (N = 240) vs. Misoprostol oral 400 μg 24 h after mifepristone (N = 240) |
21. | Raghavan et al. 2010 [31] | Randomized controlled trial | University Clinic, Municipal Clinical Hospital No.1, Chisinau, the Republic of Moldova. | Women with gestational age through 63 days by LMP presenting for abortion. Gestational age was determined by one or more assessment method: last menses method, pelvic examination and ultrasound. | Misoprostol buccal 400 μg 24 h after mifepristone (N = 277) vs. Misoprostol sublingual 400 μg 24 h after mifepristone (N = 273) |
22. | Schaff et al. 2000 [32] | Randomized controlled trial | Sixteen US primary care and referral abortion facilities. | Participants were at least 18 years old, no more than 56 days pregnant, healthy and desired an abortion. | 1) Misoprostol vaginal 800 μg 1 day later after mifepristone (N = 745) vs. 2) Misoprostol vaginal 800 μg 2 days later after mifepristone (N = 778) vs. 3) Misoprostol vaginal 800 μg 3 days later after mifepristone (N = 772) |
23. | Schaff et al. 2001 [33] | Randomized controlled trial | Multicenter study at 15 sites in United States. | Women no more than 63 days pregnant, confirmed by sonogram, desiring an abortion. | Misoprostol oral 800 μg 24 h after mifepristone and 400 μg, then another 400 μg misoprostol 2 h later, last dose no later than midnight on day 2 (N = 548) vs. Misoprostol vaginal 800 μg 24 h after mifepristone (N = 596) |
24. | Schaff et al. 2002 [34] | Randomized controlled trial | Multicenter study at 14 sites in United States | Women no more than 63 days pregnant, confirmed by sonogram, desiring an abortion. | 1) Misoprostol oral 400 μg 48 h after mifepristone (N = 220) vs. 2) Misoprostol oral 800 μg 48 h after mifepristone (N = 269) vs. 3) Misoprostol vaginal 800 μg 48 h after mifepristone (N = 522) |
25. | Shannon et al. 2006 [35] | Randomized controlled trial | Three clinics associated with major research universities in Canada; two in major urban areas and one in a periurban area. | Women aged 16 years or older, seeking elective abortion of pregnancies less than 56 days since last menstrual period or on vaginal ultrasound. | 1) Misoprostol oral 400 μg 24–48 h after mifepristone (N = 319) vs. 2) Misoprostol oral 600 μg 24–48 h after mifepristone (N = 319) vs. 3) Misoprostol vaginal 800 μg 24–48 h after mifepristone (N = 318) |
26. | Tang et al. 2003 [36] | Randomized controlled trial | Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China. | Women with gestational age of less than 9 weeks, confirmed by US, requesting legal termination of pregnancy. | Misoprostol sublingual Misoprostol sublingual 800 μg (and four tablets of vaginal placebo) 48 h after receiving mifepristone (N = 112) vs. Misoprostol vaginal Misoprostol vaginal 800 μg (and four tablets of sublingual placebo) 48 h after receiving mifepristone (N = 112) |
27. | Tendler et al. 2015 [37] | Randomized controlled trial | Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel. | Women no more than 55 days gestational age desiring medical abortion. | Misoprostol oral 400 μg 2 h after mifepristone (N = 50) vs. Misoprostol oral 400 μg 48 h after mifepristone (N = 50) |
28. | Verma et al. 2011 [13] | Randomized controlled trial | Department of Obstetrics and Gynaecology, Hind Institute of Medical Sciences, India. | Women less than 63 days of gestation choosing medical abortion. | Misoprostol vaginal 400 μg 24 h after mifepristone (N = 100) vs. Misoprostol vaginal 400 μg 48 h after mifepristone (N = 100) |
29. | Verma et al. 2017 [38] | Randomized controlled trial | Department of Obstetrics and Gynaecology, Hind Institute of Medical Sciences, India. | Women up to 63 days of gestation choosing medical abortion. | Misoprostol vaginal 400 μg simultaneously with mifepristone (N = 100) vs. Misoprostol vaginal 400 μg 48 h after mifepristone (N = 100) |
30. | Von Hertzen et al. 2007 [39] | Randomized controlled trial | Eleven gynecological centers in six countries. | Women with single intra-uterine pregnancy less than or equal to 63 days verified by US, requesting termination of pregnancy. | 1) Misoprostol 800 μg sublingual every 3 h × 3 doses (N = 517) vs. 2) Misoprostol 800 μg sublingual every 12 h × 3 doses (N = 516) vs. 3) Misoprostol 800 μg vaginal every 3 h × 3 doses (N = 516) vs. 4) Misoprostol 800 μg vaginal every 12 h × 3 doses (N = 517) |
31. | Von Hertzen et al. 2009 [40] | Randomized controlled trial | Thirteen departments of obstetrics and gynecology in nine countries. | Women with 63 days or less gestation verified by ultrasound, requesting termination of pregnancy. | 1) Mifepristone 100 mg + misoprostol 800 μg vaginal 24 h later (N = 545) vs. 2) Mifepristone 100 mg + misoprostol 800 μg vaginal 48 h later (N = 547) vs. 3) Mifepristone 200 mg + misoprostol 800 μg vaginal 24 h later (N = 544) vs. 4) Mifepristone 200 mg + misoprostol 800 μg vaginal 48 h later (N = 545) |
32. | Von Hertzen et al. 2010 [10] | Randomized controlled trial | Fifteen obstetrics/gynecology departments in ten countries. | Women requesting legal termination of pregnancy at a gestation of up to 63 days. | 1) Mifepristone 200 mg + misoprostol 400 μg sublingual 24 h later (N = 751) vs. 2) Mifepristone 200 mg + misoprostol 800 μg sublingual 24 h later (N = 752) vs. 3) Mifepristone 200 mg + misoprostol 400 μg vaginal 24 h later (N = 751) vs. 4) Mifepristone 200 mg + misoprostol 800 μg vaginal 24 h later (N = 751) |
33. | Winikoff et al. 2008 [41] | Randomized controlled trial | Seven facilities in the United States. | Women seeking medical abortion with pregnancies not exceeding 63 days since the LMP on the day of the medical abortion. Gestational age was determined by LMP, clinical examination, and/or ultrasonography, as needed. | Misoprostol oral 800 μg 24–36 h after mifepristone (N = 482) vs. Misoprostol buccal800 μg 24–36 h after mifepristone (N = 484) |