{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T18:59:29Z","timestamp":1774897169892,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,1,22]],"date-time":"2020-01-22T00:00:00Z","timestamp":1579651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000682","name":"Royal College of Obstetricians and Gynaecologists","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000682","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000682","name":"Royal College of Obstetricians and Gynaecologists","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000682","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Women are increasingly presenting for abortion at very early gestation. However, providers may be reluctant to conduct abortion at this stage as they may be concerned that they cannot exclude an ectopic pregnancy or that they may terminate a non\u2010viable pregnancy, or may be concerned that both medical and surgical methods may be less effective at this stage of gestation. This provider concern may result in delays in the abortion as additional investigations may be required until an intrauterine pregnancy can be confirmed. Additional unnecessary visits may be distressing for women and waste health service resources. The objective of this systematic review was to determine whether it is safe and effective to initiate abortion before there is ultrasound evidence of an intrauterine pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We searched Embase Classic, Embase; Ovid MEDLINE\u00ae Epub Ahead\u2010of\u2010Print, In\u2010Process &amp; Other Non\u2010Indexed Citations, Ovid MEDLINE\u00ae Daily, Ovid MEDLINE\u00ae; and Cochrane Library on 25 October 2019. Eligible studies were randomized and non\u2010randomized comparative studies, published in English from 1985, comparing initiation of abortion before there is definitive evidence of an intrauterine pregnancy with initiation afterwards. We assessed risk\u2010of\u2010bias using the Newcastle\u2010Ottowa scale. All outcomes were analyzed as risk ratios (RR) and meta\u2010analyzed using the Mantel\u2010Haenszel method. The quality of the evidence was assessed using GRADE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two non\u2010randomized studies (n\u00a0=\u00a03785) showed no differences in \u201cmissed ectopic pregnancy\u201d (RR\u00a0=\u00a00.26, 95% CI 0.03\u20102.12), \u201congoing pregnancy\u201d (RR\u00a0=\u00a01.06, 95% CI 0.34\u20103.34), or \u201ccomplete abortion without surgical intervention\u201d (RR\u00a0=\u00a01, 95% CI 0.98\u20101.02) between initiation of medical abortion before or after ultrasound evidence of an intrauterine pregnancy. A third non\u2010randomized study (n\u00a0=\u00a01530) showed no differences between initiation of surgical abortion before or after ultrasound evidence of an intrauterine pregnancy in \u201cmissed ectopic pregnancy\u201d (no events), \u201congoing pregnancy\u201d (RR\u00a0=\u00a00.56, 95% CI 0.03\u201011.59) or \u201ccomplete abortion without repeat surgical intervention\u201d (RR\u00a0=\u00a01, 95% CI 0.99\u20101.01). The quality of evidence was very low.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Initiation of abortion before there is definitive ultrasound evidence of an intrauterine pregnancy in women without signs or symptoms of an ectopic pregnancy should be considered.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13797","type":"journal-article","created":{"date-parts":[[2019,12,28]],"date-time":"2019-12-28T18:40:25Z","timestamp":1577558425000},"page":"451-458","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Initiation of abortion before there is definitive ultrasound evidence of intrauterine pregnancy: A systematic review with meta\u2010analyses"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4503-6870","authenticated-orcid":false,"given":"Mia","family":"Schmidt\u2010Hansen","sequence":"first","affiliation":[{"name":"National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Cameron","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Services NHS Lothian Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Lord","sequence":"additional","affiliation":[{"name":"Royal Cornwall Hospitals NHS Trust Truro UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elise","family":"Hasler","sequence":"additional","affiliation":[{"name":"National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,1,22]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"The care of women requesting induced abortion: evidence\u2010based clinical guideline","author":"Royal College of Obstetricians and","year":"2011"},{"key":"e_1_2_10_3_1","volume-title":"Safe abortion: technical and policy guidance for health systems","author":"World Health Organization","year":"2012"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2010.09.006"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2014-100924"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2012.10.013"},{"key":"e_1_2_10_7_1","unstructured":"HigginsJPT GreenS. editor(s).Cochrane Handbook for Systematic Reviews of InterventionsVersion 5.1.0 (updated March 2011). The Cochrane Collaboration 2011. Available fromhandbook.cochrane.org."},{"key":"e_1_2_10_8_1","unstructured":"Newcastle\u2010Ottowa scalewww.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp"},{"key":"e_1_2_10_9_1","unstructured":"Review Manager (RevMan)[Computer program]. Version 5.3.Copenhagen: The Nordic Cochrane Centre The Cochrane Collaboration 2014."},{"key":"e_1_2_10_10_1","unstructured":"GRADEpro Guideline Development Tool[Software] [Computer program]. McMaster University 2015 (developed by Evidence Prime Inc.) 2015. Available fromwww.gradepro.org."},{"key":"e_1_2_10_11_1","unstructured":"National Institute for Health and Care Excellence.Abortion care. Available from:https:\/\/www.nice.org.uk\/guidance\/NG140(accessed October 29 2019)."},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14904"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(97)70410-1"},{"key":"e_1_2_10_14_1","unstructured":"National Institute for Health and Care Excellence.Developing NICE guidelines: the manual.2014. Available from:https:\/\/www.nice.org.uk\/process\/pmg20\/chapter\/introduction-and-overviewaccessed July 31 2019."},{"key":"e_1_2_10_15_1","unstructured":"Reynolds\u2010WrightJJ.Very early medical abortion.https:\/\/clinicaltrials.gov\/show\/NCT03989869(accessed October 29 2019)."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2017.09.006"},{"key":"e_1_2_10_17_1","unstructured":"National Institute for Health and Care Excellence.Ectopic pregnancy and miscarriage: Diagnosis and initial management (CG154).2012. 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