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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.

DOI:10.1111/1471-0528.14712
PMID:28445596
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5724486/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0de7/5724486/3e06eadefcc0/BJO-124-1928-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0de7/5724486/6c3e5d796580/BJO-124-1928-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0de7/5724486/3e06eadefcc0/BJO-124-1928-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0de7/5724486/6c3e5d796580/BJO-124-1928-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0de7/5724486/3e06eadefcc0/BJO-124-1928-g002.jpg

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Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.在资源丰富环境下由助产士或医生提供的药物流产：一项成本效益分析。
PLoS One. 2016 Jun 30;11(6):e0158645. doi: 10.1371/journal.pone.0158645. eCollection 2016.
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Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends.1990年至2014年期间的堕胎发生率：全球、区域和次区域层面及趋势。
Lancet. 2016 Jul 16;388(10041):258-67. doi: 10.1016/S0140-6736(16)30380-4. Epub 2016 May 11.
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Women's Acceptability of Misoprostol Treatment for Incomplete Abortion by Midwives and Physicians - Secondary Outcome Analysis from a Randomized Controlled Equivalence Trial at District Level in Uganda.
BMJ Glob Health. 2019 Dec 17;4(6):e002150. doi: 10.1136/bmjgh-2019-002150. eCollection 2019.
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Trends in Comprehensive Abortion Care (CAC) and characteristics of women receiving abortion care in a tertiary hospital in Nepal.尼泊尔一家三级医院的综合堕胎护理（CAC）趋势及接受堕胎护理的女性特征。
BMC Womens Health. 2019 Feb 28;19(1):41. doi: 10.1186/s12905-019-0739-9.
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Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences.在权力下放背景下提供医疗终止妊娠服务：社会和结构影响。
Int J Equity Health. 2018 Nov 21;17(1):172. doi: 10.1186/s12939-018-0888-8.
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Does supportive legislation guarantee access to pregnancy termination and postabortion care services? Findings from a facility census in Central Province, Zambia.支持性立法能否确保获得终止妊娠和堕胎后护理服务？赞比亚中央省医疗机构普查结果
BMJ Glob Health. 2018 Sep 3;3(4):e000897. doi: 10.1136/bmjgh-2018-000897. eCollection 2018.
乌干达地区级随机对照等效性试验的次要结果分析：助产士和医生使用米索前列醇治疗不完全流产时女性的接受度
PLoS One. 2016 Feb 12;11(2):e0149172. doi: 10.1371/journal.pone.0149172. eCollection 2016.
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Medical students are afraid to include abortion in their future practices: in-depth interviews in Maharastra, India.医学生害怕在未来的行医中涉及堕胎：印度马哈拉施特拉邦的深度访谈
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Nurse versus physician-provision of early medical abortion in Mexico: a randomized controlled non-inferiority trial.墨西哥护士与医生提供早期药物流产服务的比较：一项随机对照非劣效性试验。
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