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JOGC

No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods

      Abstract

      Objective

      This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care.

      Intended Users

      Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs.

      Target Population

      Women with an unintended or abnormal first or second trimester pregnancy.

      Evidence

      PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications. Results were restricted to English or French systematic reviews, randomized controlled trials, clinical trials, and observational studies published from 1979 to July 2017. National and international clinical practice guidelines were consulted for review. Grey literature was not searched.

      Values

      The quality of evidence in this document was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology framework. The summary of findings is available upon request.

      Benefits, Harms, and/or Costs

      IA is safe and effective. The benefits of IA outweigh the potential harms or costs. No new direct harms or costs identified with these guidelines.

      Abbreviations:

      CHC (combined hormonal contraception), CI (confidence interval), COC (combined oral contraceptives), CS (Caesarean section), D&C (dilation and curettage), D&E (dilation and evacuation), DMPA (depo-medroxyprogesterone acetate), EC (emergency contraception), EVA (electric vacuum aspiration), EP (ectopic pregnancy), FU (follow-up), GA (gestational age), GAn (general anaesthesia), GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), GS (gestational sac), GTN (gestational trophoblastic neoplasia), hCG (human chorionic gonadotropin), IA (induced abortion), IUP (intrauterine pregnancy), DIC (disseminated intravascular coagulation), IM (intramuscular), IV (intravenous(ly)), KCl (potassium chloride), IUCD (intrauterine contraceptive device), LBW (low birth weight), MA (medical abortion), MIFE (mifepristone), MISO (misoprostol), MVA (manual vacuum aspiration), NO donors (nitric oxide donors), NSAID (non-steroidal anti-inflammatory drug), OD (synthetic osmotic dilators), OR (odds ratio), PCA (patient-controlled analgesia), PCB (paracervical block), PGF2α (prostaglandin F2α), PGE1 (prostaglandin E1), PGE2 (prostaglandin E2), POC (products of conception), PP (placenta previa), PTB (preterm birth), PUL (pregnancy of unknown location), RCT (randomized controlled trial), RR (risk ratio), SA (surgical abortion), SGA (small for gestational age), SOGC (Society of Obstetricians and Gynaecologists of Canada), UP (uterine perforation)

      Key Words

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