Background 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+0 and 23+6 weeks’ gestation for a new national guideline. Methods 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≥100 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) used the Mantel-Haenszel method. The quality of the evidence was assessed using GRADE. Results Two RCTs (n=140) were included. ‘Incomplete abortion requiring surgical intervention’ was clinically significantly higher with medical than surgical methods (RR=4.58, 95% CI 1.07 to 19.64). ‘Abortion completed by the intended method’ 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 ‘haemorrhage requiring transfusion/≥500 mL blood loss’, ‘uterine injury’, ‘cervical injury requiring repair’ and ‘infection reported within 1 month of abortion’ were reported, they did not differ significantly between methods. Depending on measurement method, ‘patient satisfaction/acceptability’ 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. Conclusion Based on this evidence and consensus, women should be offered the choice of medical or surgical methods of abortion between 13+0 and 23+6 weeks’ gestation, unless not clinically appropriate.

中文翻译：

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妊娠 13+0 至 23+6 周之间是否需要手术或药物流产？系统回顾和新的 NICE 国家指南


背景技术 妊娠中期的流产可以通过手术或药物进行。本系统评价的目的是为了制定新的国家指南，检查妊娠 13+0 至 23+6 周期间手术流产与药物流产相比的有效性、安全性和可接受性/满意度。方法 我们于 2019 年 3 月 4 日检索了 Embase、Medline 和 Cochrane 图书馆。我们纳入了 1985 年以来以英文发表的随机对照试验（RCT；任何规模）和每组 n≥100 的非随机比较研究。使用随机对照试验的 Cochrane 协作清单评估偏倚。风险比 (RR) 的荟萃分析使用 Mantel-Haenszel 方法。使用 GRADE 评估证据的质量。结果 纳入两项随机对照试验 (n=140)。药物治疗“需要手术干预的不完全流产”的发生率在临床上显着高于手术治疗（RR=4.58，95% CI 1.07 至 19.64）。药物治疗后“通过预期方法完成的流产”在统计学上显着低于手术方法，但在临床上并非如此，但其特点是研究间异质性较高（RR = 0.88，95％CI 0.79至0.98）。就报告的“需要输血的出血/失血量≥500 mL”、“子宫损伤”、“需要修复的宫颈损伤”和“流产后 1 个月内报告的感染”而言，不同方法之间没有显着差异。根据测量方法的不同，手术后的“患者满意度/可接受性”在临床上显着高于医疗方法，或者与医疗方法相当。该证据的质量受到低事件发生率和损耗偏倚的限制。 结论 基于这一证据和共识，应为妇女在妊娠 13+0 至 23+6 周之间选择药物或手术流产方法，除非临床上不合适。