{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:14:31Z","timestamp":1783602871750,"version":"3.55.0"},"reference-count":23,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2020,1,18]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Abortion in the second trimester may be performed surgically or medically. The objective of this systematic review was to examine the effectiveness, safety and acceptability\/satisfaction of surgical compared with medical abortion of pregnancy between 13<jats:sup>+0<\/jats:sup> and 23<jats:sup>+6<\/jats:sup> weeks\u2019 gestation for a new national guideline.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched Embase, Medline and the Cochrane Library on 4 March 2019. We included randomised controlled trials (RCTs; any size) and non-randomised comparative studies with n\u2265100 in each arm, published in English from 1985. Risk-of-bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs)<\/jats:p>\n                  <jats:p>used the Mantel-Haenszel method. 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>Two RCTs (n=140) were included. \u2018Incomplete abortion requiring surgical intervention\u2019 was clinically significantly higher with medical than surgical methods (RR=4.58, 95% CI 1.07 to 19.64). \u2018Abortion completed by the intended method\u2019 was statistically, but not clinically, significantly lower after medical than surgical methods, but was marked by high between-study heterogeneity (RR=0.88, 95% CI 0.79 to 0.98). To the extent that \u2018haemorrhage requiring transfusion\/\u2265500 mL blood loss\u2019, \u2018uterine injury\u2019, \u2018cervical injury requiring repair\u2019 and \u2018infection reported within 1 month of abortion\u2019 were reported, they did not differ significantly between methods. Depending on measurement method, \u2018patient satisfaction\/acceptability\u2019 was either clinically significantly higher or comparable after surgical than medical methods. The quality of this evidence was limited by low event rates and attrition bias.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Based on this evidence and consensus, women should be offered the choice of medical or surgical methods of abortion between 13<jats:sup>+0<\/jats:sup> and 23<jats:sup>+6<\/jats:sup> weeks\u2019 gestation, unless not clinically appropriate.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsrh-2019-200460","type":"journal-article","created":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T17:15:54Z","timestamp":1584465354000},"page":"e10-e10","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Surgical or medical abortion of pregnancies between 13<sup>+0<\/sup> and 23<sup>+6<\/sup> weeks\u2019 gestation? A systematic review and new NICE national guidelines"],"prefix":"10.1136","volume":"47","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":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1862-5730","authenticated-orcid":false,"given":"Patricia A","family":"Lohr","sequence":"additional","affiliation":[{"name":"British Pregnancy Advisory Service (BPAS), Stratford upon Avon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Cameron","sequence":"additional","affiliation":[{"name":"Sexual and Reproductive Health Services, NHS Lothian, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Hasler","sequence":"additional","affiliation":[{"name":"National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,3,17]]},"reference":[{"key":"2025090512171577000_47.3.e10.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2011.10.016"},{"key":"2025090512171577000_47.3.e10.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.307.6906.714"},{"key":"2025090512171577000_47.3.e10.3","doi-asserted-by":"publisher","DOI":"10.3310\/hta13320"},{"key":"2025090512171577000_47.3.e10.4","unstructured":"Royal College of Obstetricians and Gynaecologists (RCOG) . The care of women requesting induced abortion. London: RCOG, 2011."},{"key":"2025090512171577000_47.3.e10.5","unstructured":"World Health Organization (WHO) . Safe abortion: technical and policy guidance for health systems. 2nd ed. Geneva: WHO, 2012."},{"key":"2025090512171577000_47.3.e10.6","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182932f37"},{"key":"2025090512171577000_47.3.e10.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2003.09.006"},{"key":"2025090512171577000_47.3.e10.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1982.03330050041028"},{"key":"2025090512171577000_47.3.e10.9","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/0002-9378(80)90886-8","article-title":"Midtrimester abortion by dilatation and evacuation versus intra-amniotic instillation of prostaglandin F2 alpha: a randomized clinical trial","volume":"137","author":"Grimes","year":"1980","journal-title":"Am J Obstet Gynecol"},{"key":"2025090512171577000_47.3.e10.10","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/S0968-8080(08)31385-8","article-title":"An historical overview of second trimester abortion methods","volume":"16","author":"Bygdeman","year":"2008","journal-title":"Reprod Health Matters"},{"key":"2025090512171577000_47.3.e10.11","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/"},{"key":"2025090512171577000_47.3.e10.12","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/17.1.92"},{"key":"2025090512171577000_47.3.e10.13","unstructured":"National Institute for Health and Care Excellence (NICE) . Abortion care, 2019. Available: https:\/\/www.nice.org.uk\/guidance\/NG140"},{"key":"2025090512171577000_47.3.e10.14","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":"2025090512171577000_47.3.e10.15","unstructured":"Newcastle-Ottowa scale. Available: www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp"},{"key":"2025090512171577000_47.3.e10.16","unstructured":"The Nordic Cochrane Centre, The Cochrane Collaboration . Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen, 2014."},{"key":"2025090512171577000_47.3.e10.17","unstructured":"GRADEpro Guideline Development Tool [Software] [Computer program]. McMaster University, 2015 (developed by Evidence Prime, Inc.), 2015. Available: www.gradepro.org"},{"key":"2025090512171577000_47.3.e10.18","doi-asserted-by":"publisher","DOI":"10.1046\/j.1471-0528.2003.00034.x"},{"key":"2025090512171577000_47.3.e10.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02712.x"},{"key":"2025090512171577000_47.3.e10.20","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"},{"key":"2025090512171577000_47.3.e10.21","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dei216"},{"key":"2025090512171577000_47.3.e10.22","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1111\/1471-0528.14900","article-title":"Preoperative effects of mifepristone for dilation and evacuation after 19 weeks of gestation: a randomised controlled trial","volume":"124","author":"Shaw","year":"2017","journal-title":"BJOG"},{"key":"2025090512171577000_47.3.e10.23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1997.tb12028.x"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2019-200460","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T19:17:24Z","timestamp":1757099844000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2019-200460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,17]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,7,12]]},"published-print":{"date-parts":[[2021,7]]}},"alternative-id":["10.1136\/bmjsrh-2019-200460"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2019-200460","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,17]]}}}