***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to compare the oral and vaginal administration of misoprostol for cervical priming  before surgical abortion up to 63 days ' gestation . A total of 900 pregnant women , with ages ranging from 18 to 42 years , who asked for pregnancy termination , were included in this study . Women were r and omly allocated to one of the following groups : oral administration of 400 μg misoprostol , 8 h before aspiration ; and vaginal self-administration of 400 μg misoprostol , 4 h before aspiration . During admission , all subjects were checked on a 15-min basis . The preoperative cervical dilatation achieved was the main outcome assessed . The cervix was dilated ( Hegar ≥ 8) in 348 ( 78 % ) subjects from the oral treatment group and in 391 ( 87 % ) women from the vaginal treatment group ; this difference was statistically significant ( p = 0.0004 ) . The mean dilatation achieved in the oral treatment group was 8.1 mm ( SD 1.6 mm ) and it was 8.5 mm ( SD 1.5 mm ) in the vaginal treatment group ; this difference was statistically significant ( p = 0.0001 ) . The frequencies of side-effects such as nausea , vomiting , diarrhea and chills reported by women from the vaginal misoprostol group were 10 , 8 , 18 and 4 times lower , respectively , than those reported by subjects from the oral misoprostol group . In conclusion , vaginal self-administration of misoprostol was the best administration route , as it obtained the same or greater priming effectiveness of the cervix in half the time with a much lower frequency of side-effects OBJECTIVE To evaluate the efficacy of at-home medical abortion in Kazakhstan . METHODS A comparative , non-r and omized study was undertaken at three clinics in Kazakhstan between October 10 , 2013 , and November 27 , 2014 . Women who sought medical abortion and had an intrauterine pregnancy of up to 70days were enrolled . All participants took 200 mg mifepristone followed by 600μg sublingual misoprostol 24 - 48hours later . Women were offered the choice to take mifepristone at the clinic or at home ; all took misoprostol at home . Abortion completion was assessed at an in-clinic follow-up appointment scheduled for all participants 2weeks after mifepristone administration . RESULTS Of 290 enrolled women , 185 ( 63.8 % ) chose to self-administer mifepristone at home . Three ( 1.0 % ) of 289 women included in outcome analyses required surgical intervention for incomplete abortion . Therefore , the overall success rate was 99.0 % ( 95 % confidence interval 97.0%-99.7 % ) . No serious adverse events occurred . CONCLUSION Outpatient medical abortion with mifepristone and misoprostol  is safe and effective up to 70days of pregnancy . This service should be offered to women in Kazakhstan . Clinical Trials.gov : NCT02018796 Abstract Objective To examine the effectiveness , safety , and acceptability of  nurse provision of early medical abortion compared to physicians at three facilities in Mexico City . Methods We conducted a r and omized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses . The participants were pregnant women seeking abortion at a gestational duration of 70 days or less . The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 μg of misoprostol self – administered buccally at home 24 hours later . Women were instructed to return to the clinic for follow-up 7–15 days later . We did an intention-to-treat analysis for risk differences between physicians ’ and nurses ’ provision for completion and the need for surgical intervention . Findings Of 1017 eligible women , 884 women were included in the intention-to-treat analysis , 450 in the physician-provision arm and 434 in the nurse-provision arm . Women who completed medical abortion , without the need for surgical intervention , were 98.4 % ( 443/450 ) for physicians ’ provision and 97.9 % ( 425/434 ) for nurses ’ provision . The risk difference between the group was 0.5 % ( 95 % confidence interval , CI : −1.2 % to 2.3 % ) . There were no differences between providers for examined gestational duration or women ’s contraceptive method uptake . Both types of providers were rated by the women as highly acceptable . Conclusion Nurses ’ provision of medical abortion is as safe , acceptable and effective as provision by physicians in this setting . Authorizing nurses to provide medical abortion can help to meet the dem and for safe abortion services CONTEXT Misoprostol was used by women across Mexico to induce abortion even before 2007 , when first-trimester abortion was legalized in Mexico City . Pharmacy vendors ' misoprostol recommendation practice s across subregions of Mexico after abortion legalization warrant examination . METHODS Overall , 192 pharmacies in four regions of Mexico were r and omly selected and visited by simulated clients presenting three scenarios ( a young woman , an adult woman and a male partner ) . Bivariate and multivariate analyses were used to explore associations between pharmacy , vendor and client characteristics and drug access . RESULTS In 558 encounters with simulated clients , 78 % of vendors provided information about misoprostol-18 % recommended it spontaneously and 60 % recommended it only after the client asked specifically for the drug . Fifteen percent of vendors recommended a potentially effective misoprostol dosing regimen . Mexico City-based pharmacies and those in the Central region were significantly less likely than those in the North region to require a prescription to sell misoprostol  ( odds ratios , 0.2 and 0.3 , respectively ) . Independent pharmacies and those from low-?income areas were significantly more likely to sell misoprostol  by the pill than chain pharmacies and those in medium-income areas ( 3.2 and 2.7 , respectively ) . CONCLUSIONS Access to misoprostol is influenced by neighborhood socioeconomic level , pharmacy location and pharmacy type . The frequently inaccurate and incomplete information provided to clients about using misoprostol for abortion suggests the need to improve pharmacy vendor training in medication abortion options and to develop ways to directly inform women about misoprostol use OBJECTIVE We investigated safety , efficacy , and acceptability of an oral regimen of medical abortion compared with surgical abortion in three developing countries . STUDY DESIGN Women ( n = 1373 ) with amenorrhea < or = 56 days chose either surgical abortion ( as provided routinely ) or 600 mg of mifepristone followed after 48 hours by 400 micrograms of misoprostol . This is the appropriate design for study ing safety , efficacy , and acceptability among women selecting medical abortion over available surgical services . RESULTS The medical regimen had more side effects , particularly bleeding , than did surgical abortion but very few serious side effects . Failure rates for medical abortion , although low , exceeded those for surgical abortion : 8.6 % versus 0.4 % ( China ) , 16.0 % versus 4.0 % ( Cuba ) , and 5.2 % versus 0 % ( India ) . Nearly half of failures among medical clients were not true drug failures , however , but surgical interventions not medically necessary ( acceptability failures or misdiagnoses ) . Women were satisfied with either method , but more preferred medical abortion . CONCLUSION Medical abortion can be safe , efficacious , and acceptable in developing countries The aim of this study was to investigate the efficacy , safety , and acceptability of low-dose mifepristone combined with self-administered misoprostol for ultra-early medical abortion . A total of 744 women with ultra-early pregnancy ( amenorrhea ≤35 days ) who fulfilled the inclusion criteria were enrolled in the study . Equal numbers of participants were allocated r and omly to the hospital administration and self-administration groups . All participants took 75 mg mifepristone at the initial visit and 400 µg oral misoprostol 24 hours later in the hospital or by self-administration . The primary end point was complete abortion . Secondary end points were rates of unscheduled reattendance , time required for and cost of hospital observation and follow-up , vaginal bleeding , adverse effects , menstrual disturbance in the posttreatment period , and satisfaction rating . No differences in the rates of complete abortion , unscheduled reattendance , vaginal bleeding , adverse effects , or return of posttreatment menstruation were observed . The time required for ( and costs of ) hospital observation and follow-up per participant was 557.82 minutes ( and US$ 40.12 ) in the hospital administration group and 18.46 minutes ( and US$ 1.96 ) in the self-administration group ( both P < .001 ) . Satisfaction rates were similar in both groups , but the rates of “ very satisfied ” responses ( 87.60 % vs 25.41 % ) and follow-up compliance ( loss to follow-up , 0.45 % vs 7.70 % ) were higher in the self-administration group ( both P < .001 ) . Low-dose mifepristone combined with self-administered misoprostol for ultra-early pregnancy termination was as effective and safe as hospital administration , with greater acceptability and lower cost to the women OBJECTIVE To assess the efficacy and acceptability of home administration of misoprostol for early medical abortion in Indian family planning clinics . METHODS In this prospect i ve cohort study , consenting pregnant women ( n=599 ) with amenorrhea of 8 weeks or less seeking termination of pregnancy received 200 mg of oral mifepristone followed 48 hours later with 400microg of oral misoprostol , administered either at home or at the clinic . RESULTS Almost all women ( 88.4 % ) chose to take  misoprostol home . There was no statistical difference in success rates between home and clinic users ( 89.0 % vs 92.4 % , Pearson chi(2)=0.7 ; P=0.395 ) . Most women in both the home ( 90.7 % ) and clinic ( 92.3 % ) groups were satisfied or very satisfied with the procedure . CONCLUSION Home administration of misoprostol is safe and feasible for introduction into medical abortion services in India BACKGROUND Vaginal misoprostol has been shown to be an effective single agent for medical abortion . This r and omized , double-blinded , placebo-controlled trial compared a regimen of mifepristone and misoprostol with misoprostol alone for termination of early pregnancy . METHODS 250 women with gestations < or = 56 days were r and omized by a r and om number table to receive either 200 mg mifepristone orally or placebo followed 48 h later by 800 microg vaginal misoprostol . Administration of misoprostol was repeated every 24 h up to three doses if abortion failed to occur . Abortion success was defined as complete abortion without the use of surgical aspiration . RESULTS Successful medical abortions occurred in 114 out of 119 subjects ( 95.7 % ) after mifepristone followed by vaginal misoprostol . In all , 110 out of 125 subjects ( 88.0 % ) successfully aborted after placebo and vaginal misoprostol . The higher success rate of complete abortion with the mifepristone and misoprostol regimen was statistically significant compared with the placebo and misoprostol regimen ( P < 0.05 ) . CONCLUSIONS A regimen of mifepristone and misoprostol was significantly more effective for termination of pregnancies < or = 56 days than misoprostol alone . The 88 % efficacy obtained with vaginal misoprostol alone may be clinical ly acceptable when mifepristone is not available OBJECTIVE To determine the acceptability of taking mifepristone at home for early medical abortion in the United States . STUDY DESIGN This prospect i ve , non-r and omized , open-label study at six Planned Parenthood centers gave women with pregnancies up to 63 days ' gestation seeking medical abortion the choice of taking mifepristone in the center or at home . Participants were interviewed at a follow-up visit 1 - 2 weeks after mifepristone administration to assess their experience with the option they selected . RESULTS Four-hundred women were enrolled between April 2013 and June 2014 of which 32 % ( n=128 ) chose to take mifepristone at home . Abortion success rates did not differ between home and center users ( 96 % and 97 % ) . Among home users , 82 % reported taking the  mifepristone at the time they planned with their provider and no participant took it after 63 days ' gestation . The most common reason cited for selecting home use was scheduling flexibility and significantly more home users took  misoprostol on the weekend ( 50 % vs. 36 % , p=.02 ) . Home users were more likely than center users to report missing no days of work due to the abortion ( 47 % vs. 28 % , p=.08 ) . Ninety-nine percent of home users reported that they would  take mifepristone at home again and 96 % would recommend home use to a friend . Offering this option did not increase the service delivery burden on study providers 
    Output:
    
This review shows that self-administering the second stage of early medical abortion procedures is as effective as provider-administered procedures for the outcome of abortion success .
There may be no difference for the outcome of ongoing pregnancy , although the evidence for this is uncertain for this outcome .
There is very low-certainty evidence for the risk of complications requiring surgical intervention .