Department of Obstetrics & Gynecology, Westchester Medical Center / New York Medical College, Valhalla, New York, USA
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
BMJ Sex Reprod Health. 2024 Jan 9;50(1):43-52. doi: 10.1136/bmjsrh-2023-201875.
We sought to determine whether there is evidence to recommend progesterone for individuals not wishing to complete a medication abortion after taking mifepristone.
We undertook an updated systematic review including a primary search for studies in which individuals received progesterone to reverse the effects of mifepristone, and a secondary search for studies in which individuals received mifepristone alone. We searched PubMed, Embase, Cochrane, CINAHL and grey literature up to December 2022. We used the Joanna Briggs Institute critical appraisal tools for risk of bias assessment. We compared ongoing pregnancy rates among individuals treated with progesterone to those managed expectantly.
We did not find new studies in our secondary search. For the main search, we included three case series and one randomised controlled trial. Data were available for 561 individuals who received progesterone after mifepristone, of whom 271 (48%) had ongoing pregnancies. The quality of the evidence in the case series was low due to methodological and ethical issues. Enrollment in the randomised trial stopped early due to bleeding events in both arms. The ongoing pregnancy rate for individuals ≤7 weeks who received progesterone was 42% (95% CI 37-48) compared with 22% (95% CI 11-39) for mifepristone alone. At 7-8 weeks, the ongoing pregnancy rate was 62% (95% CI 52-71) in the progesterone group and 50% (95% CI 15- 85) in the mifepristone alone group.
Based mostly on poor-quality data, it appears the ongoing pregnancy rate in individuals treated with progesterone after mifepristone is not significantly higher compared to that of individuals receiving mifepristone alone.
我们试图确定在服用米非司酮后，对于那些不想完成药物流产的人，是否有证据推荐使用孕酮。
我们进行了一项更新的系统评价，包括对接受孕酮以逆转米非司酮作用的研究进行了初步检索，以及对仅接受米非司酮的研究进行了二次检索。我们检索了 PubMed、Embase、Cochrane、CINAHL 和灰色文献，截至 2022 年 12 月。我们使用了 Joanna Briggs 研究所的批判性评价工具来评估偏倚风险。我们比较了接受孕酮治疗的个体与期待治疗的个体的持续妊娠率。
我们在二次检索中没有发现新的研究。对于主要检索，我们纳入了三个病例系列和一个随机对照试验。共有 561 名在服用米非司酮后接受孕酮治疗的个体的数据可用，其中 271 名（48%）有持续妊娠。由于方法学和伦理问题，病例系列的证据质量较低。由于出血事件，随机试验的入组提前停止。在≤7 周的个体中，接受孕酮治疗的持续妊娠率为 42%（95%CI 37-48），而单独使用米非司酮的为 22%（95%CI 11-39）。在 7-8 周时，孕酮组的持续妊娠率为 62%（95%CI 52-71），米非司酮组为 50%（95%CI 15-85）。
基于质量较差的数据，似乎接受米非司酮后接受孕酮治疗的个体的持续妊娠率与单独接受米非司酮的个体相比并没有显著提高。
