Continuing pregnancy after XXXX and "reversal" of first-trimester medical abortion: a systematic review.

@entity1 @entity3927 @entity1420
OBJECTIVE: We conducted a systematic review of the literature on the effectiveness of medical abortion "reversal" treatment. Since the usual care for @entity1 seeking to continue pregnancies after ingesting @entity3927 is expectant management with fetal surveillance, we also performed a systematic review of continuing pregnancy after @entity3927 alone. STUDY DESIGN: We searched PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus and the Cochrane Library for articles published through March 2015 reporting the proportion of pregnancies continuing after treatment with either @entity3927 alone or after an additional treatment following @entity3927 aimed at reversing its effect. RESULTS: From 1115 articles retrieved, 1 study met inclusion criteria for abortion reversal, and 13 studies met criteria for continuing pregnancy after @entity3927 alone. The one report of abortion reversal was a case series of 7 @entity1 receiving varying doses of @entity1420 in oil intramuscularly or micronized @entity1420 orally or vaginally; 1 @entity1 was lost to follow-up. The study was of poor quality and lacked clear information on @entity1 selection. Four of six @entity1 continued the pregnancy to term [67%, 95% confidence interval (CI) 30-90%]. Assuming the lost @entity1 aborted resulted in a continuing pregnancy proportion of 57% (95% CI 25-84%). The proportion of pregnancies continuing 1-2 weeks after @entity3927 alone varied from 8% (95% CI 3-22%) to 46% (95% CI 37-56%). Continuing pregnancy was more common with lower @entity3927 doses and advanced gestational age. CONCLUSIONS: In the rare case that a @entity1 changes her mind after starting medical abortion, evidence is insufficient to determine whether treatment with @entity1420 after @entity3927 results in a higher proportion of continuing pregnancies compared to expectant management. IMPLICATIONS: Legislation requiring physicians to inform @entity1 about abortion reversal transforms an unproven therapy into law and represents legislative interference in the @entity1 -physician relationship.
