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Meta-Analysis
. 2010 Jan 20:(1):CD007223.
doi: 10.1002/14651858.CD007223.pub2.

Medical treatments for incomplete miscarriage (less than 24 weeks)

James P Neilson  1 , Gillian Ml Gyte, Martha Hickey, Juan C Vazquez, Lixia Dou
Affiliations
Meta-Analysis

Medical treatments for incomplete miscarriage (less than 24 weeks)

James P Neilson et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Miscarriage occurs in 10% to 15% of pregnancies. The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining pregnancy tissues in the uterus. However, it has been suggested that drug-based medical treatments, or expectant care (no treatment), may also be effective, safe and acceptable.

Objectives: To assess the effectiveness, safety and acceptability of any medical treatment for early incomplete miscarriage (before 24 weeks).

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009).

Selection criteria: Randomised controlled trials comparing medical treatment with expectant care or surgery. Quasi-randomised trials were excluded.

Data collection and analysis: Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked.

Main results: Fifteen studies (2750 women) were included, there were no studies on women over 13 weeks' gestation. Studies addressed a number of comparisons and data are therefore limited.Three trials compared misoprostol treatment (all vaginally administered) with expectant care. There was no significant difference in complete miscarriage (average risk ratio (RR) 1.23, 95% confidence interval (CI) 0.72 to 2.10; two studies, 150 women), or in the need for surgical evacuation (average RR 0.62, 95% CI 0.17 to 2.26; two studies, 308 women). There were few data on 'deaths or serious complications'.Nine studies involving 1766 women addressed the comparison of misoprostol (four oral, four vaginal, one vaginal + oral) with surgical evacuation. There was no statistically significant difference in complete miscarriage (average RR 0.96, 95% CI 0.92 to 1.00, eight studies, 1377 women) with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.07, 95% CI 0.03 to 0.18; eight studies, 1538 women) but more unplanned procedures (average RR 6.32, 95% CI 2.90 to 13.77; six studies, 1158 women). There were few data on 'deaths or serious complications'. Limited evidence suggests that women generally seem satisfied with their care. Long-term follow up from one included study identified no difference in subsequent fertility between the three approaches.

Authors' conclusions: The available evidence suggests that medical treatment, with misoprostol, and expectant care are both acceptable alternatives to routine surgical evacuation given the availability of health service resources to support all three approaches. Women experiencing miscarriage at less than 13 weeks should be offered an informed choice.

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Figures

Figure 1
Figure 1. Methodological quality summary: review authors’ judgements about each methodological quality item for each included study.
See this image and copyright information in PMC

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References

References to studies included in this review

    1. Bique C, Usta M, Debora B, Chong E, Westheimer E, Winikoff B. Comparison of misoprostol and manual vacuum aspiration for the treatment of incomplete abortion. International Journal of Gynecology & Obstetrics. 2007;98(3):222–6. - PubMed
    1. Blanchard K, Taneepanichskul S, Kiriwat O, Sirimai K, Svirirojana N, Mavimbela N, et al. Two regimens of misoprostol for treatment of incomplete abortion. Obstetrics & Gynecology. 2004;103(5 Pt 1):860–5. - PubMed
    2. Phupong V, Taneepanichskul S, Kriengsinyot R, Sriyirojana N, Blanchard K, Winikoff B. Comparative study between single dose 600 mg and repeated dose oral misoprostol for treatment of incomplete abortion. Contraception. 2004;70:307–11. - PubMed
    1. Blohm F, Friden BE, Milsom I, Platz-Christensen JJ, Nielsen S. A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage. BJOG: an international journal of obstetrics and gynaecology. 2005;Vol. 112(issue 8):1090–5. - PubMed
    1. Clevin L, Munk T, Hansen TR. Spontaneous abortion. Drug treatment versus surgery [Spontan abort. Medicinsk versus kirurgisk behandling]. Ugeskrift for Laeger. 2001;163(15):2136–9. - PubMed
    1. Dao B, Blum J, Thieba B, Raghavan S, Ouedraego M, Lankoande J, et al. Is misoprostol a safe, effective and acceptable alternative to manual vacuum aspiration for postabortion care? Results from a randomised trial in Burkina Faso, West Africa. BJOG: an international journal of obstetrics and gynaecology. 2007;114(11):1368–75. - PubMed

References to studies excluded from this review

    1. Chen BA, Reeves MF, Creinin MD, Gilles JM, Barnhart K, Westhoff C, et al. Misoprostol for treatment of early pregnancy failure in women with previous uterine surgery. American Journal of Obstetrics and Gynecology. 2008;198(6):626.e1–626.e5. - PMC - PubMed
    2. Creinin MD, Huang X, Westhoff C, Barnhart K, Gilles JM, Zhang J, et al. Factors related to successful misoprostol treatment for early pregnancy failure. Obstetrics & Gynecology. 2006;107(4):901–7. - PMC - PubMed
    3. Harwood B, Nansel T, for the National Institute of Child Health and Human Development Management of Early Pregnancy Failure Trial Quality of life and acceptability of medical versus surgical management of early pregnancy failure. BJOG: an international journal of obstetrics and gynaecology. 2008;115(4):501–8. - PMC - PubMed
    4. Reeves MF, Lohr PA, Harwood B, Creinin MD. Sonographic findings after misoprostol or vacuum aspiration for early pregnancy failure. Contraception. 2006;74(2):182.
    5. Reeves MF, Lohr PA, Harwood BJ, Creinin MD. Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure. Obstetrics & Gynecology. 2008;111(1):106–12. - PubMed
    6. Robledo C, Zhang J, Troendle J, Barnhart K, Creinin MD, Westhoff C, et al. Clinical indicators for success of misoprostol treatment after early pregnancy failure. International Journal of Gynecology & Obstetrics. 2007;99(1):46–51. - PMC - PubMed
    7. Zhang J, Gilles J, Barnhart K, Creinin M, Westhoff C, Frederick MM. Medical management with misoprostol for early pregnancy failure: a multicenter, randomized equivalence trial [abstract] Fertility and Sterility. 2004;82(Suppl 2):S53–4.
    8. Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM, et al. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. New England Journal of Medicine. 2005;353(8):761–9. - PubMed
    1. Abdel Fattah IH. PGE1 analogue for the induction of midtrimester abortion in cases of intrauterine fetal death. Acta Obstetricia et Gynecologica Scandinavica Supplement. 1997;76(167:2):26.
    1. Al-Bdour AN, Akasheh H, Al-Jayousi T. Missed abortion: termination using single-dose versus two doses of vaginal misoprostol tablets. Pakistan Journal of Medical Sciences. 2007;23(6):920–3.
    1. Al Inizi SA, Ezimokhai M. Vaginal misoprostol versus dinoprostone for the management of missed abortion. International Journal of Gynecology & Obstetrics. 2003;83:73–4. - PubMed
    1. Almog B, Levin I, Winkler N, Fainaru O, Pauzner D, Lessing JB, et al. The contribution of laminaria placement for cervical ripening in second trimester termination of pregnancy induced by intra-amniotic injection of prostaglandin f(2)alpha followed by concentrated oxytocin infusion. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2005;118:32–5. - PubMed

References to studies awaiting assessment

    1. Altaf F, Sultana N, Iqbal N. Therapeutic abortions; efficacy of intra-vaginal misoprostol in comparison to extra amniotically administered prostaglandin f2a. Professional Medical Journal. 2006;13(3):417–22.
    1. Anderson J, Gouk E, Young L, Turnbull L, Sayeed G, Elattar A, et al. A randomised controlled trial of oral versus vaginal misoprostol for medical management of early fetal demise. International Journal of Gynecology & Obstetrics. 2009;107(Suppl 2):S533.
    1. Ara G, Nargis S, Khatun R, Saha A. Vaginal misoprostol as a medical management in early pregnancy loss. International Journal of Gynecology & Obstetrics. 2009;107(Suppl 2):S533–4.
    1. Arellano M, Durocher J, Leon W, Montesinos R, Pena M, Winikoff B. Introduction of misoprostol for incomplete abortion care in Latin Amerca: evidence from Ecuador. International Journal of Gynecology & Obstetrics. 2009;107(Suppl 2):S49. - PubMed
    1. Azra B, Shakeel S, Nilofer M. A comparison of two protocols of intra vaginal misoprostol for second trimester medical termination of pregnancy. Pakistan Armed Forces Medical Journal. 2007;57(1):61–5.

References to ongoing studies

    1. Unkels R. [accessed 9 April 2008];Is misoprostol a safe alternative to manual vacuum aspiration in women with early pregnancy failure in a low resource setting?: a randomized controlled trial. http://www.controlled-trials.com/ISRCTN65305620/

Additional references

    1. Aleman A, Althabe F, Belizán J, Bergel E. Bed rest during pregnancy for preventing miscarriage. Cochrane Database of Systematic Reviews. 2005;(Issue 2) [DOI: 10.1002/14651858.CD003576.pub2] - PMC - PubMed
    1. Alfirevic Z, Weeks A. Oral misoprostol for induction of labour. Cochrane Database of Systematic Reviews. 2006;(Issue 2) [DOI: 10.1002/14651858.CD001338.pub2] - PubMed
    1. Ankum WM, Wieringa-de Waard M, Bindels PJE. Management of spontaneous miscarriage in the first trimester: an example of putting informed shared decision making into practice. BMJ. 2001;322:1343–6. - PMC - PubMed
    1. Arthur P, Taggart MJ, Mitchell BF. Oxytocin and parturition: a role for increased myometrial calcium and calcium sensitization? Frontiers in Bioscience. 2007;12:619–33. - PubMed
    1. Bamigboye AA, Morris J. Oestrogen supplementation, mainly diethylstilbestrol, for preventing miscarriages and other adverse pregnancy outcomes. Cochrane Database of Systematic Reviews. 2003;(Issue 3) [DOI: 10.1002/14651858.CD004353] - PMC - PubMed

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