First-trimester, non-medication abortion-related complication rates: A meta-analysis

Background: Published data on first-trimester, non-medication abortion-related complication rates range widely from 1.3% to 4.4% (+/- 1%). There is also variability in how abortion-related complications are defined across studies. Thus, clinicians' and researchers' ability to evaluate and compare complication rates has been limited. This meta-analysis aims to estimate a mean overall complication rate for first-trimester, non-medication abortions performed by trained clinicians worldwide, and to identify factors (e.g., clinician type, procedure type, obstetric history) that contribute to this rate. Additionally, mean rates of specific complications (e.g., hemorrhage, perforation, infection) will be estimated. Methods: A comprehensive search of PubMed, CINAHL, Web of Science, ScienceDirect, and Medline will be performed to identify published research reporting complication rates of first-trimester, non-medication abortions performed by trained clinicians. Studies reporting data from abortions performed beyond the first-trimester, or studies focusing on interventions to improve complication rates will be excluded. Meta-analytic methods will be used to determine significant predictors of abortion complication rates. Results: Overall and specific mean complication rates will be calculated and the effects of potential predictors will be estimated. Conclusions: We will perform a meta-analytic, systematic review of literature to estimate mean complication rates for first-trimester, non-medication abortions performed by trained clinicians. These rates will be useful in the evaluation of clinical and policy interventions aimed at improving abortion-related patient outcomes. Additionally, identifying factors that contribute to abortion complication rates will help direct future research questions and clinical practice changes.