Predictors and prediction models for complications of early medical abortion: a scoping review

Despite its overall safety and efficacy, early medical abortion (EMA) may result in complications. Understanding factors predicting these complications is essential for improving clinical risk assessment by healthcare providers and guiding effective management of complications associated with EMA. The purpose of this scoping review is to systematically map the existing evidence of predictors and prediction models of complications associated with EMA.

We conducted a comprehensive literature search using databases with Embase (OVID), Medline (OVID), Scopus and Web of Science. Studies were included if they presented evidence on the predictors and prediction models of complications associated with EMA. Retrieved articles were screened using Covidence. A descriptive and narrative synthesis of the included studies was conducted to summarise findings across studies.

Thirteen studies were included in the final synthesis. Pain, incomplete abortion and retained products of conception, continuing pregnancy, heavy bleeding requiring transfusion and infection were the most frequently addressed complications associated with EMA. Gestational age was identified as a key determinant across major complications of EMA. Two studies included the development of a model to predict surgical intervention following EMA demonstrating moderate discriminatory performance (AUC 63%).

This review highlights an evidence gap in the identification of predictors and the development of clinical prediction models for complications associated with EMA. Future research using larger prospective studies is needed to identify the predictors and develop individualised prediction models for assessing the risk of complications in patients undergoing EMA to support evidence-based clinical decision-making in post-abortion care.