Universidad Peruana de Ciencias Aplicadas, Escuela de Medicina, Lima, Peru.
Universidad de San Martín de Porres, Chiclayo, Peru.
PLoS One. 2021 Dec 28;16(12):e0260794. doi: 10.1371/journal.pone.0260794. eCollection 2021.
To assess the effects of peri-abortion contraceptive counseling interventions.
We performed a systematic review of randomized controlled trials (RCTs) that compared the effect of different types of peri-abortion contraceptive counseling interventions and were published as original papers in scientific journals. The literature search was performed in June 2021 in PubMed, Central Cochrane Library (CENTRAL), Scopus, and Google Scholar; without restrictions in language or publication date. Two independent authors identified studies that met the inclusion and exclusion criteria and extracted the data. The risk of bias was assessed using the Cochrane tool, and evidence certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Whenever possible, meta-analyses were performed. The protocol was registered at PROSPERO (CRD42020187354).
Eleven RCTs were eligible for inclusion (published from 2004 to 2017), from which nine compared enhanced versus standard counseling. Pooled estimates showed that, compared to standard counseling, enhanced counseling was associated with a higher incidence of effective contraceptive use (>3 months) (relative risk [RR], 1.12; 95% confidence interval [CI], 1.09-1.16), although no significant difference was found in the incidence of long-acting reversible contraceptive use (RR, 1.25; 95% CI, 0.68-2.29), contraceptive uptake (RR, 1.06; 95% CI, 0.98-1.15), and obstetric event occurrence (RR, 0.91; 95% CI, 0.57-1.47). Certainty of evidence was very low for all outcomes. In addition, two studies compared contraceptive counseling provided by physicians versus that provided by non-physicians, which did not show significant differences.
Enhanced contraceptive counseling may favor effective contraceptive use but may not affect the rate of obstetric event occurrence. Also, the studies did not find a difference in the effects of counseling interventions given by different providers. Since evidence certainty was very low, future well-designed RCTs are needed to make informed decisions.
The study protocol was registered at PROSPERO (CRD42020187354).
评估流产前避孕咨询干预的效果。
我们对比较不同类型流产前避孕咨询干预效果的随机对照试验（RCT）进行了系统评价，并将其作为原始论文发表在科学期刊上。文献检索于 2021 年 6 月在 PubMed、Cochrane 中心图书馆（CENTRAL）、Scopus 和 Google Scholar 进行，不限制语言或出版日期。两位独立的作者确定了符合纳入和排除标准并提取数据的研究。使用 Cochrane 工具评估偏倚风险，并使用推荐评估、制定与评价（GRADE）方法评估证据确定性。只要有可能，就进行荟萃分析。该方案已在 PROSPERO（CRD42020187354）中注册。
11 项 RCT 符合纳入标准（发表于 2004 年至 2017 年），其中 9 项比较了强化咨询与标准咨询。汇总估计表明，与标准咨询相比，强化咨询与有效避孕措施（>3 个月）的发生率更高（相对风险 [RR]，1.12；95%置信区间 [CI]，1.09-1.16），尽管长效可逆避孕措施的使用率（RR，1.25；95% CI，0.68-2.29）、避孕措施采用率（RR，1.06；95% CI，0.98-1.15）和产科事件发生率（RR，0.91；95% CI，0.57-1.47）无显著差异。所有结局的证据确定性均非常低。此外，有两项研究比较了医生与非医生提供的避孕咨询，结果未显示出显著差异。
强化避孕咨询可能有利于有效避孕，但可能不会影响产科事件的发生率。此外，研究并未发现不同提供者提供的咨询干预效果存在差异。由于证据确定性非常低，因此需要进行精心设计的 RCT 以做出明智的决策。
该研究方案已在 PROSPERO（CRD42020187354）中注册。
