Stewart Hannah, McCall Stephen J, McPherson Calum, Towers Lucinda C, Lloyd Bethany, Fletcher Jack, Bhattacharya Sohinee
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
Obstetric Epidemiology, Division of Applied Health Sciences, Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen, UK National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
J Fam Plann Reprod Health Care. 2016 Jan;42(1):59-67. doi: 10.1136/jfprhc-2014-101096. Epub 2015 Sep 7.
This systematic review and meta-analysis assessed whether enhanced peri-abortion contraceptive counselling had an effect on subsequent unplanned pregnancies and the uptake and continuation of contraceptive methods.
A systematic review of English-language articles published prior to May 2014 was conducted, using MEDLINE, EMBASE and the Cochrane Library. Only randomised controlled trials (RCTs) involving enhanced pre- and post-abortion contraceptive counselling were included. The authors independently applied the inclusion and exclusion criteria to the identified records, and extracted data from each included paper using a predefined extraction form. Risk of bias was assessed using the Cochrane Collaboration's tool. Meta-analyses were undertaken where appropriate and based on random effects models.
Six RCTs met the inclusion criteria. Three RCTs investigated the effect of enhanced counselling on subsequent unplanned pregnancy. The results of the meta-analysis were non-significant [pooled odds ratio (OR) 0.47; 95% confidence interval (95% CI) 0.12-1.90]. Four RCTs reported results relating to the uptake of long-acting reversible contraception (LARC) and continuation of chosen method of contraception at 3 months. Findings were non-significant (pooled OR 1.07; 95% CI 0.20-5.69 and pooled OR 3.22; 95% CI 0.85-12.22, respectively).
This review found no evidence of effect resulting from enhanced peri-abortion contraceptive counselling on subsequent unplanned pregnancy rate or the uptake of LARC. However, these findings are limited by the small number of relevant studies available and the marked heterogeneity between published studies. Further, larger-scale RCTs should be undertaken to ensure that there is sufficient power to detect an effect.
本系统评价和荟萃分析评估了强化流产前后避孕咨询是否对后续意外妊娠以及避孕方法的采用和持续使用产生影响。
使用MEDLINE、EMBASE和Cochrane图书馆对2014年5月之前发表的英文文章进行系统评价。仅纳入涉及强化流产前后避孕咨询的随机对照试验（RCT）。作者独立将纳入和排除标准应用于识别出的记录，并使用预定义的提取表从每篇纳入论文中提取数据。使用Cochrane协作工具评估偏倚风险。在适当情况下并基于随机效应模型进行荟萃分析。
六项RCT符合纳入标准。三项RCT研究了强化咨询对后续意外妊娠的影响。荟萃分析结果无统计学意义[合并优势比（OR）0.47；95%置信区间（95%CI）0.12 - 1.90]。四项RCT报告了与长效可逆避孕方法（LARC）的采用以及3个月时所选避孕方法的持续使用相关的结果。结果无统计学意义（合并OR分别为1.07；95%CI 0.20 - 5.69和合并OR 3.22；95%CI 0.85 - 12.22）。
本评价未发现强化流产前后避孕咨询对后续意外妊娠率或LARC的采用有影响的证据。然而，这些发现受到现有相关研究数量少以及已发表研究之间显著异质性的限制。此外，应进行更大规模的RCT以确保有足够的检验效能来检测效应。
