{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T12:10:14Z","timestamp":1771589414429,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,11,28]],"date-time":"2020-11-28T00:00:00Z","timestamp":1606521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100010377","name":"National Institute for Health and Care Excellence","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010377","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":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The safety and acceptability of medical abortion using mifepristone and misoprostol at home at \u22649<jats:sup>+0<\/jats:sup>\u00a0weeks\u2019 gestation is well established. However, the upper gestational limit at which the procedure remains safe and acceptable at home is not known. To inform a national guideline on abortion care we conducted a systematic review to determine what gestational limit for expulsion at home offers the best balance of benefits and harms for women who are having medical abortion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We searched Embase, MEDLINE, Cochrane Library, Cinahl Plus and Web\u2010of\u2010Science on 2\u00a0January 2020 for prospective and retrospective cohort studies with \u226550 women per gestational age group, published in English from 1995 onwards, that included women undergoing medical abortion and compared home expulsion of pregnancies of \u22649<jats:sup>+0<\/jats:sup>\u00a0weeks\u2019 gestational age with pregnancies of 9<jats:sup>+1<\/jats:sup>\u201010<jats:sup>+0<\/jats:sup>\u00a0weeks or &gt;10<jats:sup>+1<\/jats:sup>\u00a0weeks\u2019 gestational age, or compared the latter two gestational age groups. We assessed risk\u2010of\u2010bias using the Newcastle\u2010Ottowa scale. All outcomes were meta\u2010analyzed as risk ratios (RR) using the Mantel\u2010Haenszel method. The certainty of the evidence was assessed using GRADE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies (n\u00a0=\u00a03381) were included. The \u201cneed for emergency care\/admission to hospital\u201d (RR\u00a0=\u00a00.79, 95% confidence interval [CI]\u00a00.45\u20101.4), \u201chemorrhage requiring transfusion\/\u2265500\u00a0mL blood loss\u201d (RR\u00a0=\u00a00.62, 95% CI 0.11\u20103.55), patient satisfaction (RR\u00a0=\u00a00.99, 95% CI 0.95\u20101.03), pain (RR\u00a0=\u00a00.91, 95% CI 0.82\u20101.02), and \u201ccomplete abortion without the need for surgical intervention\u201d (RR\u00a0=\u00a01.03, 95% CI 1\u20101.05) did not differ statistically significantly between the \u22649<jats:sup>+0<\/jats:sup> and &gt;9<jats:sup>+0<\/jats:sup>\u00a0weeks\u2019 gestation groups. The rates of vomiting (RR\u00a0=\u00a00.8, 95% CI 0.69\u20100.93) and diarrhea (RR\u00a0=\u00a00.85, 95% CI 0.73\u20100.99) were statistically significantly lower in the \u22649<jats:sup>+0<\/jats:sup>\u00a0weeks group but these differences were not considered clinically important. We found no studies comparing pregnancies of 9<jats:sup>+1<\/jats:sup>\u201010<jats:sup>+0<\/jats:sup>\u00a0weeks\u2019 gestation with pregnancies of &gt;10<jats:sup>+0<\/jats:sup>\u00a0weeks\u2019 gestation. The certainty of this evidence was predominantly low and mainly compromised by low event rates and loss to follow up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Women who are having a medical abortion and will be taking mifepristone up to and including 10<jats:sup>+0<\/jats:sup>\u00a0weeks\u2019 gestation should be offered the option of expulsion at home after they have taken the misoprostol. Further research needs to determine whether the gestational limit for home expulsion can be extended beyond 10<jats:sup>+0<\/jats:sup>\u00a0weeks.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14025","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T10:35:50Z","timestamp":1602844550000},"page":"727-735","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Expulsion at home for early medical abortion: A systematic review with meta\u2010analyses"],"prefix":"10.1111","volume":"100","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":"Anuja","family":"Pandey","sequence":"additional","affiliation":[{"name":"Amaris Consulting Work Life \u2010 Camden London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia A.","family":"Lohr","sequence":"additional","affiliation":[{"name":"British Pregnancy Advisory Service Stratford upon Avon UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Nevill","sequence":"additional","affiliation":[{"name":"British Pregnancy Advisory Service Stratford upon Avon UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Taylor","sequence":"additional","affiliation":[{"name":"NA Wilson Associates Ltd Norwich 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"}]},{"given":"Sharon","family":"Cameron","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Services NHS Lothian Edinburgh Scotland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1996.tb09633.x"},{"key":"e_1_2_11_3_1","unstructured":"WHO.Medical management of abortion 2019. 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