{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T18:48:36Z","timestamp":1757616516048,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2020,1,6]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Medical abortion with mifepristone and misoprostol usually involves an interval of 36\u201348\u2009hours between administering these drugs; however, it is possible that the clinical efficacy at early gestations may be maintained when the drugs are taken simultaneously. The objective of this systematic review was to determine the safety and effectiveness of simultaneous compared with interval administration of mifepristone and misoprostol for abortion up to 10<jats:sup>+0<\/jats:sup> weeks\u2019 gestation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched Embase Classic, Embase; Ovid MEDLINE(R) including Daily, and Epub Ahead-of-Print, In-Process &amp; Other Non-Indexed Citations; and Cochrane Library on 11 December 2019. We included randomised controlled trials (RCTs), published in English from 1985, comparing simultaneous to interval administration of mifepristone and misoprostol for early abortion. Risk of bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs) using the Mantel-Haenszel method were performed. The quality of the evidence was assessed using GRADE.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Meta-analyses of three RCTs (n=1280) showed no differences in \u2018ongoing pregnancy\u2019 (RR 1.78, 95%\u2009CI 0.38 to 8.36), \u2018haemorrhage requiring transfusion or \u2265500\u2009mL blood loss\u2019 (RR 0.11, 95%\u2009CI 0.01 to 2.03) and \u2018incomplete abortion with the need for surgical intervention\u2019 (RR 1.30, 95%\u2009CI 0.76 to 2.25) between the interventions. Individual study results showed no difference in patient satisfaction, or \u2018need for repeat misoprostol\u2019, although \u2018time to onset of bleeding or cramping\u2019 was longer after simultaneous than interval administration. The quality of evidence was very low to moderate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The published data support the use of simultaneous mifepristone and misoprostol for medical abortion up to 9<jats:sup>+0<\/jats:sup> weeks in women who prefer this method of administration.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2019-200448","type":"journal-article","created":{"date-parts":[[2020,2,20]],"date-time":"2020-02-20T17:15:37Z","timestamp":1582218937000},"page":"270-278","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Simultaneous compared to interval administration of mifepristone and misoprostol for medical abortion up to 10<sup>+0<\/sup> weeks' gestation: a systematic review with meta-analyses"],"prefix":"10.1136","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4503-6870","authenticated-orcid":false,"given":"Mia","family":"Schmidt-Hansen","sequence":"first","affiliation":[{"name":"National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2819-5973","authenticated-orcid":false,"given":"Jonathan","family":"Lord","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, 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"}]},{"given":"Sharon","family":"Cameron","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Services, NHS Lothian, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,20]]},"reference":[{"key":"2025090512150860000_46.4.270.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2006.03.009"},{"key":"2025090512150860000_46.4.270.2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000258298.35143.d2"},{"key":"2025090512150860000_46.4.270.3","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1007\/s00404-011-1881-2","article-title":"Simultaneous administration of mifepristone and misoprostol for early termination of pregnancy: a randomized controlled trial","volume":"283","author":"Goel","year":"2011","journal-title":"Arch Gynecol Obstet"},{"key":"2025090512150860000_46.4.270.4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/14647273.2016.1243817","article-title":"Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy","volume":"20","author":"Verma","year":"2017","journal-title":"Hum Fertil"},{"key":"2025090512150860000_46.4.270.5","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/AOG.0000000000002536","article-title":"Simultaneous compared with interval medical abortion regimens where home use is restricted","volume":"131","author":"Lohr","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2025090512150860000_46.4.270.6","unstructured":"Scottish Government. Chief Medical Officer Directorate . Abortion - improvement to existing services - approval for misoprostol to be taken at home. Available: https:\/\/www.sehd.scot.nhs.uk\/cmo\/CMO(2017)14.pdf [Accessed 29 May 2019]."},{"key":"2025090512150860000_46.4.270.7","unstructured":"Welsh Government . Written statement - approval for misoprostol to be take at home for medical termination of pregnancy. Available: https:\/\/gov.wales\/written-statement-approval-misoprostol-be-take-home-medical-termination-pregnancy [Accessed 29 May 2019]."},{"key":"2025090512150860000_46.4.270.8","unstructured":"UK Government. Department of Health and Social Care . Approval of home use for the second stage of early medical abortion. Available: https:\/\/www.gov.uk\/government\/publications\/approval-of-home-use-for-the-second-stage-of-early-medical-abortion [Accessed 29 May 2019]."},{"key":"2025090512150860000_46.4.270.9","unstructured":"National Institute for Health and Care Excellence (NICE) . Abortion care, 2019. Available: https:\/\/www.nice.org.uk\/guidance\/GID-NG10058\/documents\/draft-guideline [Accessed 17 Dec 2019]."},{"key":"2025090512150860000_46.4.270.10","unstructured":"Higgins JPT , Green S , eds. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration, 2011. handbook.cochrane.org"},{"key":"2025090512150860000_46.4.270.11","unstructured":"Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration 2014."},{"key":"2025090512150860000_46.4.270.12","unstructured":"GRADEpro Guideline Development Tool [Software] [Computer program]. McMaster University, 2015 (developed by Evidence Prime, Inc.), 2015. Available: www.gradepro.org"},{"key":"2025090512150860000_46.4.270.13","unstructured":"World Health Organisation (WHO) . Medical management of abortion, 2019. Available: https:\/\/www.who.int\/reproductivehealth\/publications\/medical-management-abortion\/en\/ [Accessed 17 Dec 2019]."},{"key":"2025090512150860000_46.4.270.14","unstructured":"National Institute for Health and Care Excellence (NICE) . Developing NICE guidelines: the manual, 2014. Available: https:\/\/www.nice.org.uk\/process\/pmg20\/chapter\/introduction-and-overview [Accessed 17 Dec 2019]."},{"key":"2025090512150860000_46.4.270.15","article-title":"Medical methods for first trimester abortion","volume":"11","author":"Kulier","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2025090512150860000_46.4.270.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2018-200134"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2019-200448","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T19:15:25Z","timestamp":1757099725000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2019-200448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,20]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,10,12]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/bmjsrh-2019-200448"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2019-200448","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"type":"print","value":"2515-1991"},{"type":"electronic","value":"2515-2009"}],"subject":[],"published":{"date-parts":[[2020,2,20]]}}}