This Evidence Overview provides a summary of the evidence on reducing the burden of unintended pregnancies in terms of two main packages of care: family planning and safe abortion. For each of these packages the scope and magnitude of benefits to women and to broader society is reviewed and the component interventions and delivery modalities outlined. The main body of the paper then synthesizes the evidence on interventions to reduce barriers to the supply of and demand for these services including estimates of cost-effectiveness. (excerpt)

Improving reproductive maternal and newborn health: reducing unintended pregnancies. Evidence overview. A working paper (version 1.0).

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2012.05.007

Study of knowledge and attitudes on medical abortion among Chinese health providers

La pérdida gestacional precoz acontece en el 10-20% de todas las gestaciones clínicas, siendo el 85% previos a la semana 12 de amenorrea. El aborto involuntario conlleva una carga muy significativa en los recursos destinados a sanidad, alcanzado un coste económico nacional en Reino Unido de 471 millones de libras esterlinas por año (533,06 millones de euros), cifra extrapolable a otros países industrializados. Según una revisión sistemática reciente no hay ensayos bien diseñados en gestaciones del primer trimestre que arrojen una evidencia consolidada sobre cuál es el mejor método de tratamiento de aborto del primer trimestre y existen diferentes estudios que han tratado de evidenciar reducción de costes con resultados contradictorios. Se realiza un estudio de diseño observacional, retrospectivo y longitudinal. Se revisaron 892 pacientes diagnosticadas de aborto espontáneo durante el primer trimestre de gestación, en el periodo comprendido entre enero de 2013 y diciembre de 2016. En nuestro estudio hemos querido evaluar la efectividad del misoprostol vaginal como tratamiento médico para el aborto espontáneo en el primer trimestre, en comparación con el legrado obstétrico/evacuador y, cuantificar la diferencia en los costos de ambos procedimientos a través de un estudio de minimización de costes. De las 892 pacientes reclutadas, se realizó tratamiento médico con misoprostol en 517 (57,95%) y tratamiento quirúrgico mediante legrado evacuador en 375 (42,05%). La efectividad del tratamiento médico fue del 82% (426/517). Con respecto al tratamiento quirúrgico la efectividad resultó del 100%. La tasa de éxito del tratamiento médico fue superior en el subgrupo de pacientes con aborto incompleto (92,9%), en comparación con los grupos de gestación anembrionada (85,7%) y aborto diferido (78,2%). El tratamiento médico del aborto es un manejo seguro y aceptado por las pacientes. La selección adecuada de las pacientes candidatas conlleva un aumento en la tasa de éxito y la disminución de costes. En nuestro estudio se determinó un importante ahorro total de 576.847,92 € (37,14%) respecto al tratamiento quirúrgico. Dado que la efectividad es comparable y la satisfacción de las pacientes alta, aunque mejorable, consideramos, que con la adecuada información y homogeneización del tratamiento aplicado, aumentará. Early pregnancy loss occurs in 10-20% of all clinical pregnancies, 85% being prior to week 12 of amenorrhea. Miscarriage entails a very significant burden on healthcare resources, reaching a national economic cost in the United Kingdom of £471 million per year (€533.06 million), a figure that can be extrapolated to other industrialized countries. According to a recent systematic review, there are no well-designed trials in first-trimester pregnancies that provide consolidated evidence on what is the best first-trimester abortion treatment method, and there are different studies that have tried to demonstrate cost reduction with contradictory results. An observational, retrospective and longitudinal design study was carried out. 892 patients diagnosed with spontaneous abortion during the first trimester of pregnancy were reviewed, in the period between January 2013 and December 2016. In our study, we wanted to evaluate the efficacy of vaginal misoprostol as a medical treatment for spontaneous abortion in the first trimester, in comparison with obstetric curettage-evacuator, and to quantify the difference in the costs of both procedures through a cost minimization study. costs. Of the 892 recruited patients, medical treatment with misoprostol was performed in 517 (57.95%) and surgical treatment by curettage in 375 (42.05%). The effectiveness of medical treatment was 82% (426/517). With respect to surgical treatment the effectiveness of 100%. The success rate of medical treatment was higher in the subgroup of patients with incomplete abortion (92.9%), compared to the anembryonic gestation (85.7%) and delayed abortion (78.2%) groups. The medical treatment of abortion is a safe management and accepted by the patients. The adequate selection of candidate patients leads to an increase in the success rate and a decrease in costs. In our study, an important total saving of €576,847.92 (37.14%) with respect to surgical treatment will be reduced. Given that the effectiveness is comparable and patient satisfaction is high, although it could be improved, we believe that with adequate information and homogenization of the applied treatment, it is safe. 

Tratamiento médico del aborto del primer trimestre: igual eficacia, más eficiencia

OBJECTIVE To analyze and evaluate the acceptability of mifepristone compatible with misoprostone versus conventional surgical abortion among women under unwanted early pregnancy, so as to help the unexpected pregnant women to choose the satisfactory abortion, and to provide the evidence for clinicians to make a proper clinical decision METHODS Six medical databases were searched, including MEDLINE, EMBASE, Cochrane library, CBMdisc, CNKI and VIP, together with twelve journals hand-searched, and references of included studies additionally searched Two qualified reviewers reviewed the original articles, evaluating qualities of articles, and extracting data independently After heterogeneity test, the data was pooled using Revman software if capable, or descriptive analysis was applied RESULTS In total, nine original clinical controlled trials were included, containing 3565 cases Before abortion, more unwanted pregnant women chose the medical abortion because they believed medical abortion was less painful than surgical abortion (OR = 46651, 95% CI: 9137 - 238188), but medical abortion was less time-consuming than surgical abortion (OR = 002, 95% CI: 001 - 006) After abortion, satisfaction with medical abortion was similar to that with surgical abortion, with insignificant difference (P = 089) However, second choice and recommendation rates of medical abortion were much higher than those of surgical abortion with OR and 95% CI as 272, 213 - 347 and 419, 216 - 1116, respectively CONCLUSIONS Medical abortion was less painful than surgical abortion and the rate of second choice and recommendation to others were all also higher than those of surgical abortion However, the process of medical abortion was not as quick as surgical abortion but the satifacation of both methods seemed similar Therefore, the two artificial abortion methods were not recommended to replace each other at the present time

Study on Meta analysis regarding the acceptability of medical abortion compared with surgical abortion

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Study on Meta analysis regarding the acceptability of medical abortion compared with surgical abortion