Review articleComprehensive analysis of the use of pre-procedure ultrasound for first- and second-trimester abortion☆
Introduction
Ultrasound assessment before an abortion procedure during first or second trimester of pregnancy has been recommended in some guidelines, although it is supported by little evidence [1], [2]. In settings where ultrasound (US) is widely used and easily available, its use for confirming intrauterine pregnancy, assessing gestational age as well as excluding ectopic pregnancy or uterine malformations has often become routine before performing abortion [3], [4], [5].
Assessment of gestational age by US in the first trimester is obligatory in some countries (for example, Switzerland), in order to be able to offer the choice for medical or surgical abortion, as well as to confirm that the pregnancy is within the legal limits for termination. In the second trimester, besides assessing gestational age, possible anomalies of the pregnancy, such as placenta previa, may be detected and precautions can be taken accordingly [6]. On the other hand, routine US can be costly, possibly unnecessary and may increase training and maintenance requirements in already under-resourced settings. Additionally, use of US can introduce error into pre-abortion assessment as its accuracy is dependant upon training, equipment and case volume.
The objective of this review was to determine whether the use of pre-procedure US, when compared to no use of US, prior to first- or second-trimester medical or surgical abortion affects either the safety or the efficacy of the procedure.
Section snippets
Types of studies
Randomized controlled trials (RCTs) would be the ideal study design to address our objective in a research setting using both excellent clinicians and sonographers. However, in the absence of RCTs, we considered all study designs comparing the use of pre-procedure US to no use of US. Studies needed to report on the use of pre-procedure US for safety or efficacy outcomes in first- and second-trimester medical or surgical abortion.
Types of participants
Women pregnant in the first or second trimester requesting
Results
Our search revealed about 750 citations, which were scrutinized by the two authors (RK, NK), and 25 full text papers were obtained. Evaluation of the full-text articles was performed by both authors.
We did not identify any systematic reviews, randomized controlled trials or reports of any comparative studies of the use of pre-procedure US with no use of US for either safety or efficacy outcomes.
Discussion
Ultrasound in some settings is used commonly to assess pregnancies in women before they undergo abortion. There is no evidence available, however, whether this practice improves either the safety or efficacy of abortion procedures.
Although no studies reported on our outcomes of interest, pre-procedure US has been studied to answer other questions. We report on these studies identified by our search strategy but not meeting inclusion criteria, as they may inform the decision-making process
Implications for practice
There is no evidence available on the effects of pre-procedure US for first- and second-trimester abortion with regard to either safety or efficacy, despite the fact that US in some settings is widely used to estimate gestational age and to detect pregnancy abnormalities. Any implications for routine US may be greater for pregnancies beyond the first trimester, where appropriate procedures for abortion change with increasing gestational age.
Implications for research
The use of resources to research this issue is
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Cited by (23)
Barriers and Facilitators to the Implementation of First Trimester Medical Abortion With Mifepristone in the Province of Québec: A Qualitative Investigation
2020, Journal of Obstetrics and Gynaecology CanadaProviding Abortion Services in the Primary Care Setting
2018, Primary Care - Clinics in Office PracticeCitation Excerpt :GA can be accurately diagnosed with patient history of LMPs and use of clinical pelvic examination or ultrasound.39,40 Although ultrasound is widely used, it is not required for first-trimester abortion.52,53 Routine use of ultrasound has not been shown to improve the safety or efficacy of abortion but should be used when GA is uncertain or when there are symptoms of bleeding or pain.53
A noninferiority randomized controlled trial to compare transabdominal and transvaginal sonography for eligibility assessment prior to medical abortion
2018, ContraceptionCitation Excerpt :The routine use of TVS may be a holdover from early clinical trials of medical abortion efficacy, but sonography persists as an element of care for many clinicians despite insufficient evidence that it is necessary for all patients [20–23]. In 2011, Kulier and Kapp [24] reviewed the literature on preabortion ultrasound evaluations and found no published data addressing its impact on abortion safety or efficacy in either the first or second trimester. Some clinicians do provide medical abortion without using ultrasound first, but many hesitate to do so without first evaluating the pregnancy location and gestational age.
N<sup>o</sup> 360 - Avortement provoqué: avortement chirurgical et méthodes médicales au deuxième trimestre
2018, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Qualité des preuves : basse.) Avant un AP, il est recommandé d'effectuer une échographie systématique, car la détermination de l'âge gestationnel (AG) est essentielle21. Il a aussi été montré qu'une échographie peropératoire réalisée dans le cadre d'un AC au deuxième trimestre diminue les complications comme la perforation utérine22.
No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods
2018, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Level of evidence: Low). Routine ultrasound prior to IA is recommended, as determination of GA is critical.21 In second trimester SA, intraoperative ultrasound has been shown to decrease complications including uterine perforation (UP).22
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Funded by UNDP/UNFPA/WHO/World Bank Special Programme of Research: Human Reproduction Programme (HRP).