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Meta-Analysis
. 2019 Dec;147(3):301-312.
doi: 10.1002/ijgo.12964. Epub 2019 Sep 25.

A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14-28 weeks of gestation

Amanda Cleeve  1   2 , Marita Sporstøl Fønhus  3 , Antonella Lavelanet  2
Affiliations
Meta-Analysis

A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14-28 weeks of gestation

Amanda Cleeve et al. Int J Gynaecol Obstet. 2019 Dec.

Abstract

Background: Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established.

Objectives: To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD.

Search strategy: Research databases from January 2006 to October 2018.

Selection criteria: Randomized controlled trials with IUFD cases at 14-28 weeks of gestation.

Data collection and analysis: We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence.

Main results: Sixteen trials from 1695 citations. When misoprostol is used alone, 400 μg is more effective than 200 μg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low.

Conclusions: Misoprostol 400 μg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.

Keywords: Intrauterine fetal death; Medical management; Mifepristone; Misoprostol; Second trimester; Systematic review.

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References

REFERENCES

    1. Gomez Ponce de Leon R, Wing D, Fiala C. Misoprostol for intrauterine fetal death. Int J Gynecol Obstet. 2007;99(Suppl 2):S190-S193.
    1. Opsjøn BE, Vogt C. Explaining fetal death-what are the contributions of fetal autopsy and placenta examination? Pediatr Dev Pathol. 2016;19:24-30.
    1. Liu LC, Huang HB, Yu MH, Su HY. Analysis of intrauterine fetal demise-a hospital-based study in Taiwan over a decade. Taiwan J Obstet Gynecol. 2013;52:546-550.
    1. Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: Pharmacokinetic profiles, effects on the uterus and side-effects. Int J Gynecol Obstet. 2007;99(Suppl 2):S160-S167.
    1. Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N. Medical methods for mid-trimester termination of pregnancy. Cochrane Database Syst Rev. 2011;(1):CD005216.

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