不安全的堕胎是全球大量孕产妇死亡和发病率的原因,特别是在低收入和中等收入国家。非医生提供的药物流产方法可能是减轻不安全流产负担的一种方法。目前,仅有一项系统评价,比较了非医师与医师的药物流产情况.然而,该审查没有任何设置限制,并且此后发布了新的证据。因此,这篇综述旨在评估有效性,可接受性,与低收入和中等收入国家的医生相比,非医生管理的妊娠早期流产的安全性。
数据库PubMed,科克伦图书馆,全球健康图书馆,和EMBASE使用结构化搜索策略进行搜索。Further,在试验注册中心clinicaltrials.gov和国际临床试验注册平台中搜索已发表和未发表的试验.纳入了比较低收入或中等收入国家非医师与医师提供药物流产的随机对照试验。使用Cochrane偏差风险工具评估偏差风险。荟萃分析中纳入了报告对完全流产的医疗方法有效性估计的试验。该协议已在PROSPERO数据库中注册,ID:CRD42020176811。
纳入了来自四个不同随机对照试验的六篇论文,共有4021名参与者。四个纳入的试验中有两个被评估为总体偏倚风险较低。四篇论文有关于完全流产的结果数据,并被纳入荟萃分析。发现由非医生提供的妊娠早期流产的医学管理和不完全流产的医学治疗与由医生提供的医学治疗同样有效(风险比1.00;95%CI0.99-1.01)。Further,治疗同样安全,与医生相比,非医生提供治疗的女性同样满意。
在妊娠早期提供药物流产或不完全流产的药物治疗同样有效,安全,与低收入和中等收入国家的医生相比,非医生提供时可以接受。我们建议,在低收入和中等收入国家为不完全流产提供药物流产和药物治疗的任务应该与非医生分担。
Unsafe abortion is the cause of a substantial number of maternal mortalities and morbidities globally, but specifically in low- and middle-income countries. Medical abortion methods provided by non-physicians may be a way to reduce the burden of unsafe abortions. Currently, only one systematic
review comparing non-physicians with physicians for medical abortion exists. However, the
review does not have any setting restrictions and newer evidence has since been published. Therefore, this
review aims to evaluate the effectiveness, acceptability, and safety of first-trimester abortion managed by non-physicians compared with physicians in low- and middle-income countries.
The databases PubMed, Cochrane Library, Global Health Library, and EMBASE were searched using a structured search strategy. Further, the trial registries clinicaltrials.gov and The International Clinical Trial Registry Platform were searched for published and unpublished trials. Randomized controlled trials comparing provision of medical abortion by non-physicians with that by physicians in low- or middle-income countries were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Trials that reported effect estimates on the effectiveness of medical methods on complete abortion were included in the meta-analysis. The protocol was prospectively registered in the PROSPERO database, ID: CRD42020176811.
Six papers from four different randomized controlled trials with a total of 4021 participants were included. Two of the four included trials were assessed to have overall low risk of bias. Four papers had outcome data on complete abortion and were included in the meta-analyses. Medical management of first-trimester abortion and medical treatment of incomplete abortion were found to be equally effective when provided by a non-physician as when provided by a physician (risk ratio 1.00; 95% CI 0.99-1.01). Further, the treatment was equally safe, and women were equally satisfied when a non-physician provided the treatment compared with a physician.
Provision of medical abortion or medical treatment for incomplete abortion in the first trimester is equally effective, safe, and acceptable when provided by non-physicians compared with physicians in low- and middle-income countries. We recommend that the task of providing medical abortion and medical treatment for incomplete abortion in low- and middle-income countries should be shared with non-physicians.