Massive waste in obstetric prediction research

Many complex healthcare interventions aim to change the behaviour of patients or health professionals, e.g. stopping smoking or prescribing fewer antibiotics. This prompts the question of which behaviour change interventions are most effective. Synthesising evidence on the effectiveness of a particular type of behaviour change intervention can be challenging because of the high levels of heterogeneity in trial design. Here we use data from a published systematic review as a case study and compare alternative methods to address this heterogeneity. One important sources of heterogeneity is that compliance to a desired behaviour can be measured and reported in a variety of different ways. In addition, interventions designed to target behaviour can be implemented at either an individual or group level leading to trials with varying layers of clustering. To handle heterogeneous outcomes we can either convert all effect estimates to a common scale (e.g. using standardised mean differences) or have separate meta-analyses for different types of outcome measure (binary and continuous measures).To address the clustering structure, adjusted standard errors can be used with the inverse variance method, or weights can be assigned based on a consistent level of clustering, such as the number of healthcare professionals. A graphical method, the albatross plot utilises reported p-values only, and can synthesise data with both heterogeneous outcomes and clustering with minimal assumption and data manipulation. Based on these methods, we reanalysed our data in four different ways and have discussed the strengths and weaknesses of each approach.

Objective: This study aims to provide insight into the use, acceptability and outcome of a large group of women who self-managed medical abortion. Design: Retrospective cohort study. Setting: Self-managed abortion worldwide. Population/Sample: 30344 women who completed the follow up from of the telemedical abortion service Women on Web from January 2009 till January 2020. Methods: Analyses of the evaluation forms, binary logistic regressions were performed to test the association between year and outcomes for the total sample. Main outcome measures: Demographic information including age, economic situation, country of living,knowledge about abortion pills and acceptability. Rate of complete abortions, surgical interventions, ongoing pregnancies, blood transfusions per year. Results: 30344 women from 183 different countries completed the follow-up evaluation. In total 26076 women reported taking the medical abortion pills, of which 1.5% reported an ongoing pregnancy, 10.2% a surgical intervention, and 0.6% a blood transfusion. 99% found it to be an acceptable method. 35% found it difficult to make a donation for the service and 8.5% received the service for free. 59.2% reported that they knew about medical abortion before finding Women on Web. We found a significant increase in complete abortions in 2019 (OR= 1.92; 95% CI: 1.59 – 2.31), and decrease in surgical interventions (OR= 0.49; 95%CI: 0.40 – 0.60) compared to 2009. Conclusion: The findings of the outcomes of the 26076 self-managed abortions in this study are in line with previous research , suggesting medical abortion through telemedicine is safe, effective and highly acceptable to women.