Effect of oral contraceptive for post-abortion care in China: A systematic review
ESC Congress Library. Cheng L. May 4, 2016; 126978; A-152 Disclosure(s): This study was funded by Bayer China
Prof. Dr. Linan Cheng
Prof. Dr. Linan Cheng
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Abstract
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Objective

In the lack of evidence consistently supporting the effect of OC for post abortion care, we performed this systematic review and meta-analysis to examine the effect of OC post abortion on duration and volume of vaginal bleeding, menstruation recovery time, endometrial thickness, associated complications and unintended pregnancy again.

Design and Methods

We have searched 8 major authorized Chinese and English databases from January 1960 to November 2014. Relevant research literatures were retrieved concerning OC use post medical or surgical abortion. In this review included Chinese randomized clinical trials (RCTs) and divided them in 3 groups (OC post-medical abortion [Group 1], OC post-surgical abortion [Group 2] or OC+ uterotonic post-surgical abortion [Group 3]). Jadad scale was adopted to assess quality of RCTs. Two independent authors screened titles and abstracts, selected relevant studies and extracted data. Meta-analysis was performed using RevMan 5.3.5 software. A significance level of α = .05 was used for the statistical tests.

Results

119 studies were included in this review: 10 studies in Group 1 included 1712 participants; 31 studies in Group 2 included 8788 participants; and 78 studies in Group 3 included 19,707 participants. Meta-analysis demonstrated that OC significantly reduced  the duration and volume of vaginal bleeding and the duration of menstrual recovery  in Group 1 (MD=-3.1, 95%CI [-4.68, -1.51]; MD=-18.09, 95% CI [-34.04, -2.13] and MD=-7.97 95% CI [-9.28, -6.67] respectively), Group 2 (MD=-2.46, 95% CI[-2.90, -2.02]; MD=-11.54, 95% CI [-18.67, -4.40] and MD=-8.50, 95% CI [-9.66, -7.34] respectively) and Group 3 (MD=-2.37, 95% CI [-2.70, -2.05]; MD= -20.80, 95% CI [-25.24, -16.35] and MD= -7.62, 95% CI [-8.49, -6.74] respectively). Moreover, endometrial thickness was significantly more favorable for OC users 2-3 weeks after abortion in Group 2 or 3. OC users were also significantly less likely to have PID, intrauterine or cervical adhesion, amenorrhea and unintended pregnancy again in Group 2 or 3. Funnel plots were used to demonstrate the possibility of publication bias.

Conclusion

Use of OC immediately after abortion may reduce the duration and volume of vaginal bleeding, shorten the duration of next menstruation, increase endometrial thickness 2-3 weeks after abortion, and reduce risks of complications and unintended pregnancies again. However, more studies with large sample sizes are demanded to confirm these conclusions due to limitation of the quantity of and quality of included studies.

 

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