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Contraception. 2011 Feb;83(2):116-26. doi: 10.1016/j.contraception.2010.07.014. Epub 2010 Aug 30.

Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review.

Author information

  • 1Promoting Family Planning, Department of Reproductive Health and Research, World Health Organization, CH-1211 Geneva 27, Switzerland. jacksonemi@who.int

Abstract

BACKGROUND:

Pain is a predictable feature of medical abortion in both the first trimester and the second trimester. We sought to evaluate optimal analgesia regimens during medical abortion.

STUDY DESIGN:

We searched the PubMed and Cochrane databases from inception to March 2010 for publications of trials comparing methods of pain control during first-trimester medical abortion (<12 completed weeks' gestation) and second-trimester medical abortion (13-24 completed weeks' gestation). Standard data abstraction templates were used to systematically assess and summarize data.

RESULTS:

Of 363 articles, 10 articles reporting the results of nine studies met inclusion criteria. Heterogeneity of analgesia regimens and medical abortion protocols prevented meta-analysis. Four studies conducted in women with pregnancies <8 completed weeks' gestation found that prophylactic acetaminophen, acetaminophen+codeine, ibuprofen or alverine did not reduce medical abortion pain; however, administration of ibuprofen after onset of cramping reduced pain and subsequent analgesia use. In second-trimester medical abortion, one study found that women treated with fentanyl (50 mcg) patient-controlled analgesia (PCA) had better satisfaction and pain relief than women treated with fentanyl (25 mcg) or morphine PCA, but found no difference in delivery/demand ratio; three studies found little effect of adjuvant treatment with metoclopramide or paracervical block on pain; one study found that women at >15 weeks' gestation who received diclofenac with the first misoprostol dose required less opioid analgesia than women who received acetaminophen+codeine.

CONCLUSION:

Few studies examine pain management during medical abortion, and heterogeneity of existing data limits comparison. Further research is needed to determine the optimal analgesia regimens for first-trimester and second-trimester medical termination of pregnancy. To facilitate comparability of data, researchers should use contemporary medical abortion regimens, outcomes and study instruments to measure pain.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID:
21237336
[PubMed - indexed for MEDLINE]
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