非医生提供者在妊娠早期实施人工流产的有效性、安全性和可接受性：系统评价。
Effectiveness, safety, and acceptability of first-trimester medical termination of pregnancy performed by non-doctor providers: a systematic review.
机构信息
Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health, World Health Organization, Geneva, Switzerland.
出版信息
BJOG. 2017 Dec;124(13):1928-1940. doi: 10.1111/1471-0528.14712. Epub 2017 Aug 17.
BACKGROUND
Previous systematic reviews have concluded that medical termination of pregnancy (TOP) performed by non-doctor providers may be as effective and safe as when provided by doctors. Medical treatment of incomplete miscarriage by non-doctor providers and the treated women's acceptance of non-doctor providers of TOP has not previously been reviewed.
OBJECTIVES
To review the effectiveness, safety, and acceptability of first-trimester medical TOP, including medical treatment for incomplete miscarriage, by trained non-doctor providers.
SEARCH STRATEGY AND SELECTION CRITERIA
A search strategy using appropriate medical subject headings was developed. Electronic databases (PubMed, Popline, Cochrane, CINAHL, Embase, and ClinicalTrials.gov) were searched from inception through April 2016. Randomised controlled trials and comparative observational studies were included.
DATA COLLECTION AND ANALYSIS
Meta-analyses were performed for included randomised controlled trials regarding the outcomes of effectiveness and acceptability to women. Certainty of evidence was established using the GRADE approach assessing study limitations, consistency of effect, imprecision, indirectness and publication bias.
MAIN RESULTS
Six papers were included. Medical TOP and medical treatment of incomplete miscarriage is probably equally effective when performed by non-doctor providers as when performed by doctors (RR 1.00; 95% CI 0.99-1.01). Women's acceptance, reported as overall satisfaction with the allocated provider, is probably equally high between groups (RR 1.00; 95% CI 1.00-1.01).
CONCLUSION
Medical TOP and medical treatment of incomplete miscarriage provided by trained non-doctor providers is probably equally as effective and acceptable to women as when provided by doctors.
TWEETABLE ABSTRACT
Medical termination of pregnancy performed by doctors and non-doctors can be equally effective and acceptable.
背景
之前的系统评价得出结论，由非医生提供者进行的医疗终止妊娠（TOP）可能与由医生提供的一样有效和安全。非医生提供者对不完全流产的医疗处理以及接受 TOP 的非医生提供者的妇女尚未进行过审查。
目的
审查由经过培训的非医生提供者进行的早孕医疗 TOP（包括不完全流产的医疗处理）的有效性、安全性和可接受性。
检索策略和选择标准
制定了使用适当的医学主题词的检索策略。从开始到 2016 年 4 月，检索了电子数据库（PubMed、Popline、Cochrane、CINAHL、Embase 和 ClinicalTrials.gov）。纳入了随机对照试验和比较观察性研究。
数据收集和分析
对纳入的随机对照试验进行了关于有效性和对妇女可接受性的结果的荟萃分析。使用 GRADE 方法评估研究局限性、效应一致性、不精确性、间接性和发表偏倚来确定证据的确定性。
主要结果
纳入了 6 篇论文。非医生提供者进行的医疗 TOP 和不完全流产的医疗处理可能与医生进行的一样有效（RR 1.00；95%CI 0.99-1.01）。报告的对分配提供者的总体满意度可能表明妇女的接受程度在两组之间相等（RR 1.00；95%CI 1.00-1.01）。
结论
由经过培训的非医生提供者提供的医疗 TOP 和不完全流产的医疗处理对妇女可能与医生提供的一样有效和可接受。
推文摘要
医生和非医生进行的医疗终止妊娠可能同样有效且可接受。
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