Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 1;6(6):CD012602.
doi: 10.1002/14651858.CD012602.pub2.

Methods for managing miscarriage: a network meta-analysis

Jay Ghosh  1 , Argyro Papadopoulou  1 , Adam J Devall  1 , Hannah C Jeffery  1 , Leanne E Beeson  2 , Vivian Do  3 , Malcolm J Price  4 , Aurelio Tobias  1 , Özge Tunçalp  5 , Antonella Lavelanet  5 , Ahmet Metin Gülmezoglu  6 , Arri Coomarasamy  1 , Ioannis D Gallos  1
Affiliations

Methods for managing miscarriage: a network meta-analysis

Jay Ghosh et al. Cochrane Database Syst Rev. .

Abstract

Background: Miscarriage, defined as the spontaneous loss of a pregnancy before 24 weeks' gestation, is common with approximately 25% of women experiencing a miscarriage in their lifetime. An estimated 15% of pregnancies end in miscarriage. Miscarriage can lead to serious morbidity, including haemorrhage, infection, and even death, particularly in settings without adequate healthcare provision. Early miscarriages occur during the first 14 weeks of pregnancy, and can be managed expectantly, medically or surgically. However, there is uncertainty about the relative effectiveness and risks of each option.

Objectives: To estimate the relative effectiveness and safety profiles for the different management methods for early miscarriage, and to provide rankings of the available methods according to their effectiveness, safety, and side-effect profile using a network meta-analysis.

Search methods: We searched the Cochrane Pregnancy and Childbirth's Trials Register (9 February 2021), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (12 February 2021), and reference lists of retrieved studies.

Selection criteria: We included all randomised controlled trials assessing the effectiveness or safety of methods for miscarriage management. Early miscarriage was defined as less than or equal to 14 weeks of gestation, and included missed and incomplete miscarriage. Management of late miscarriages after 14 weeks of gestation (often referred to as intrauterine fetal deaths) was not eligible for inclusion in the review. Cluster- and quasi-randomised trials were eligible for inclusion. Randomised trials published only as abstracts were eligible if sufficient information could be retrieved. We excluded non-randomised trials.

Data collection and analysis: At least three review authors independently assessed the trials for inclusion and risk of bias, extracted data and checked them for accuracy. We estimated the relative effects and rankings for the primary outcomes of complete miscarriage and composite outcome of death or serious complications. The certainty of evidence was assessed using GRADE. Relative effects for the primary outcomes are reported subgrouped by the type of miscarriage (incomplete and missed miscarriage). We also performed pairwise meta-analyses and network meta-analysis to determine the relative effects and rankings of all available methods.

Main results: Our network meta-analysis included 78 randomised trials involving 17,795 women from 37 countries. Most trials (71/78) were conducted in hospital settings and included women with missed or incomplete miscarriage. Across 158 trial arms, the following methods were used: 51 trial arms (33%) used misoprostol; 50 (32%) used suction aspiration; 26 (16%) used expectant management or placebo; 17 (11%) used dilatation and curettage; 11 (6%) used mifepristone plus misoprostol; and three (2%) used suction aspiration plus cervical preparation. Of these 78 studies, 71 (90%) contributed data in a usable form for meta-analysis. Complete miscarriage Based on the relative effects from the network meta-analysis of 59 trials (12,591 women), we found that five methods may be more effective than expectant management or placebo for achieving a complete miscarriage: · suction aspiration after cervical preparation (risk ratio (RR) 2.12, 95% confidence interval (CI) 1.41 to 3.20, low-certainty evidence), · dilatation and curettage (RR 1.49, 95% CI 1.26 to 1.75, low-certainty evidence), · suction aspiration (RR 1.44, 95% CI 1.29 to 1.62, low-certainty evidence), · mifepristone plus misoprostol (RR 1.42, 95% CI 1.22 to 1.66, moderate-certainty evidence), · misoprostol (RR 1.30, 95% CI 1.16 to 1.46, low-certainty evidence). The highest ranked surgical method was suction aspiration after cervical preparation. The highest ranked non-surgical treatment was mifepristone plus misoprostol. All surgical methods were ranked higher than medical methods, which in turn ranked above expectant management or placebo. Composite outcome of death and serious complications Based on the relative effects from the network meta-analysis of 35 trials (8161 women), we found that four methods with available data were compatible with a wide range of treatment effects compared with expectant management or placebo: · dilatation and curettage (RR 0.43, 95% CI 0.17 to 1.06, low-certainty evidence), · suction aspiration (RR 0.55, 95% CI 0.23 to 1.32, low-certainty evidence), · misoprostol (RR 0.50, 95% CI 0.22 to 1.15, low-certainty evidence), · mifepristone plus misoprostol (RR 0.76, 95% CI 0.31 to 1.84, low-certainty evidence). Importantly, no deaths were reported in these studies, thus this composite outcome was entirely composed of serious complications, including blood transfusions, uterine perforations, hysterectomies, and intensive care unit admissions. Expectant management and placebo ranked the lowest when compared with alternative treatment interventions. Subgroup analyses by type of miscarriage (missed or incomplete) agreed with the overall analysis in that surgical methods were the most effective treatment, followed by medical methods and then expectant management or placebo, but there are possible subgroup differences in the effectiveness of the available methods. AUTHORS' CONCLUSIONS: Based on relative effects from the network meta-analysis, all surgical and medical methods for managing a miscarriage may be more effective than expectant management or placebo. Surgical methods were ranked highest for managing a miscarriage, followed by medical methods, which in turn ranked above expectant management or placebo. Expectant management or placebo had the highest chance of serious complications, including the need for unplanned or emergency surgery. A subgroup analysis showed that surgical and medical methods may be more beneficial in women with missed miscarriage compared to women with incomplete miscarriage. Since type of miscarriage (missed and incomplete) appears to be a source of inconsistency and heterogeneity within these data, we acknowledge that the main network meta-analysis may be unreliable. However, we plan to explore this further in future updates and consider the primary analysis as separate networks for missed and incomplete miscarriage.

Trial registration: ClinicalTrials.gov NCT00190294 NCT03148314 NCT00835731 NCT01844024 NCT00784797 NCT02480543 NCT02201732 NCT02669420 NCT00141895 NCT00466999 NCT01539408.

PubMed Disclaimer

Conflict of interest statement

Jay Ghosh: Grants and contracts ‐ this work is supported by Tommy's Charity who fund the Tommy's National Centre for Miscarriage Research, which is held by Prof Arri Coomarasamy. Work related to the topic of the review as health professional ‐ O&G Medical Doctor.

Argyro Papadopoulou: I am currently a PhD student at the University of Birmingham, UK. My tuition fees are paid by Tommy's charity.

Adam J Devall: co‐investigator for the MifeMiso trial now published in the Lancet, which was funded by the NIHR HTA programme. AJD did not participate in any decisions regarding this trial (i.e. assessment for inclusion/exclusion, trial quality, data extraction) for the purposes of this review or future updates, these tasks have been carried out by other members of the team who were not directly involved in the trial.

Hannah C Jeffery: none known.

Leanne E Beeson: co‐investigator for the MifeMiso trial now published in the Lancet, which was funded by the NIHR HTA programme. LEB did not participate in any decisions regarding this trial (i.e. assessment for inclusion/exclusion, trial quality, data extraction) for the purposes of this review or future updates, these tasks have been carried out by other members of the team who were not directly involved in the trial.

Vivian Do: none known.

Malcolm J Price:none known.

Aurelio Tobias: none known.

Özge Tunçalp: none known.

Antonella Lavelanet: I published work as a freelance writer. I am a board certified OBGYN, but I am currently not practicing and have not practiced for the last 4 years.

Ahmet Metin Gülmezoglu: none known.

Arri Coomarasamy: chief‐investigator for the MifeMiso trial now published in the Lancet, which was funded by the NIHR HTA programme. AC did not participate in any decisions regarding this trial (i.e. assessment for inclusion/exclusion, trial quality, data extraction) for the purposes of this review or future updates, these tasks have been carried out by other members of the team who were not directly involved in the trial.

Ioannis D Gallos: co‐investigator for the MifeMiso trial now published in the Lancet, which was funded by the NIHR HTA programme. IDG did not participate in any decisions regarding this trial (i.e. assessment for inclusion/exclusion, trial quality, data extraction) for the purposes of this review or future updates, these tasks have been carried out by other members of the team who were not directly involved in the trial.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Network diagram for outcome of complete miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
5
5
Cumulative rankogram comparing each of the methods of management of a miscarriage for incomplete miscarriage subgroup analysis for the outcome of complete miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
6
6
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of complete miscarriage.
7
7
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of complete miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
8
8
Network diagram for outcome of composite outcome of death or serious complication. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
9
9
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of composite outcome of death or serious complication.
10
10
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of composite outcome of death or serious complication. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
11
11
Network diagram for outcome of need for unplanned/ emergency surgical procedure. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
12
12
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of need for unplanned/ emergency surgical procedure.
13
13
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of need for unplanned/ emergency surgical procedure. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
14
14
Network diagram for outcome of pain score (visual analogue scale). The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
15
15
Network diagram for outcome of pelvic inflammatory disease, sepsis or endometritis. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
16
16
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of pelvic inflammatory disease, sepsis or endometritis.
17
17
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of pelvic inflammatory disease, sepsis or endometritis. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
18
18
Network diagram for outcome of mean volumes of blood loss (millilitres). The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. Multi‐arm trials contribute to more than one comparison.
19
19
Network diagram for outcome of change in haemoglobin measurements before and after the miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
20
20
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of change in haemoglobin measurements before and after the miscarriage.
21
21
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of change in haemoglobin measurements before and after the miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
22
22
Network diagram for outcome of days of bleeding. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
23
23
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of days of bleeding.
24
24
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of days of bleeding. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
25
25
Network diagram for outcome of mean duration of hospital stay (days). The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. Multi‐arm trials contribute to more than one comparison.
26
26
Network diagram for outcome of readmission to hospital. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
27
27
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of readmission to hospital.
28
28
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of readmission to hospital. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
29
29
Network diagram for outcome of nausea. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
30
30
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of nausea.
31
31
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of nausea. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
32
32
Network diagram for outcome of vomiting. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
33
33
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of vomiting.
34
34
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of vomiting. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
35
35
Network diagram for outcome of diarrhoea. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
36
36
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of diarrhoea.
37
37
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of diarrhoea. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
38
38
Network diagram for outcome of pyrexia. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
39
39
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of pyrexia.
40
40
Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of pyrexia. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
41
41
Network diagram for missed miscarriage subgroup analysis of outcome of complete miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
42
42
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for missed miscarriage subgroup of complete miscarriage outcome.
43
43
Cumulative rankogram comparing each of the methods of management of a miscarriage for missed miscarriage subgroup analysis for the outcome of complete miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
44
44
Network diagram for missed miscarriage subgroup analysis of outcome of days of bleeding. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
45
45
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for missed miscarriage subgroup of the days of bleeding outcome.
46
46
Cumulative rankogram comparing each of the methods of management of a miscarriage for missed miscarriage subgroup analysis for the outcome of days of bleeding. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
47
47
Network diagram for incomplete miscarriage subgroup analysis of outcome of complete miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
48
48
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for incomplete miscarriage subgroup of complete miscarriage outcome.
49
49
Network diagram for incomplete miscarriage subgroup analysis of outcome of days of bleeding. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.
50
50
Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for incomplete miscarriage subgroup of the days of bleeding outcome.
51
51
Cumulative rankogram comparing each of the methods of management of a miscarriage for incomplete miscarriage subgroup analysis for the outcome of days of bleeding. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.
1.1
1.1. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 1: Complete Miscarriage
1.2
1.2. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 2: Composite outcome of death or serious complication
1.3
1.3. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 3: Need for unplanned/emergency surgical procedure
1.4
1.4. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 4: Pain score
1.5
1.5. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis
1.6
1.6. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 6: Change in haemoglobin measurements before and after the miscarriage
1.7
1.7. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 7: Days of bleeding
1.8
1.8. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 8: Cervical tear
1.9
1.9. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 9: Mean duration of hospital stay (days)
1.10
1.10. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 10: Re‐admission to hospital
1.11
1.11. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 11: Nausea
1.12
1.12. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 12: Vomiting
1.13
1.13. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 13: Diarrhoea
1.14
1.14. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 14: Pyrexia
1.15
1.15. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 15: Anxiety score
1.16
1.16. Analysis
Comparison 1: Suction aspiration vs Misoprostol, Outcome 16: Depression score
2.1
2.1. Analysis
Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 1: Complete Miscarriage
2.2
2.2. Analysis
Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 2: Composite outcome of death or serious complication
2.3
2.3. Analysis
Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 3: Need for unplanned/emergency surgical procedure
2.4
2.4. Analysis
Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis
2.5
2.5. Analysis
Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 5: Re‐admission to hospital
3.1
3.1. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 1: Complete Miscarriage
3.2
3.2. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 2: Composite outcome of death or serious complication
3.3
3.3. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 3: Need for unplanned/emergency surgical procedure
3.4
3.4. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis
3.5
3.5. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 5: Mean volumes of blood loss (millilitres)
3.6
3.6. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 6: Change in haemoglobin measurements before and after the miscarriage
3.7
3.7. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 7: Days of bleeding
3.8
3.8. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 8: Cervical tear
3.9
3.9. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 9: Mean duration of hospital stay (days)
3.10
3.10. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 10: Re‐admission to hospital
3.11
3.11. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 11: Vomiting
3.12
3.12. Analysis
Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 12: Pyrexia
4.1
4.1. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 1: Complete Miscarriage
4.2
4.2. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 2: Composite outcome of death or serious complication
4.3
4.3. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 3: Need for unplanned/emergency surgical procedure
4.4
4.4. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis
4.5
4.5. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 5: Mean volumes of blood loss (millilitres)
4.6
4.6. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 6: Change in haemoglobin measurements before and after the miscarriage
4.7
4.7. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 7: Days of bleeding
4.8
4.8. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 8: Cervical tear
4.9
4.9. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 9: Mean duration of hospital stay (days)
4.10
4.10. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 10: Re‐admission to hospital
4.11
4.11. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 11: Vomiting
4.12
4.12. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 12: Diarrhoea
4.13
4.13. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 13: Pyrexia
4.14
4.14. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 14: Anxiety score
4.15
4.15. Analysis
Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 15: Depression score
5.1
5.1. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 1: Complete Miscarriage
5.2
5.2. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 2: Composite outcome of death or serious complication
5.3
5.3. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 3: Need for unplanned/emergency surgical procedure
5.4
5.4. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis
5.5
5.5. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 5: Change in haemoglobin measurements before and after the miscarriage
5.6
5.6. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 6: Days of bleeding
5.7
5.7. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 7: Re‐admission to hospital
5.8
5.8. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 8: Nausea
5.9
5.9. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 9: Vomiting
5.10
5.10. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 10: Diarrhoea
5.11
5.11. Analysis
Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 11: Pyrexia
6.1
6.1. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 1: Complete Miscarriage
6.2
6.2. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 2: Composite outcome of death or serious complication
6.3
6.3. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 3: Need for unplanned/emergency surgical procedure
6.4
6.4. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 4: Pain score
6.5
6.5. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis
6.6
6.6. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 6: Mean volumes of blood loss (millilitres)
6.7
6.7. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 7: Days of bleeding
6.8
6.8. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 8: Cervical tear
6.9
6.9. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 9: Re‐admission to hospital
6.10
6.10. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 10: Vomiting
6.11
6.11. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 11: Nausea
6.12
6.12. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 12: Diarrhoea
6.13
6.13. Analysis
Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 13: Depression score
7.1
7.1. Analysis
Comparison 7: Misoprostol vs Suction aspiration + Cervical preparation, Outcome 1: Complete Miscarriage
7.2
7.2. Analysis
Comparison 7: Misoprostol vs Suction aspiration + Cervical preparation, Outcome 2: Pyrexia
8.1
8.1. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 1: Complete Miscarriage
8.2
8.2. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 2: Composite outcome of death or serious complication
8.3
8.3. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 3: Need for unplanned/emergency surgical procedure
8.4
8.4. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 4: Pain score
8.5
8.5. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis
8.6
8.6. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 6: Change in haemoglobin measurements before and after the miscarriage
8.7
8.7. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 7: Days of bleeding
8.8
8.8. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 8: Mean duration of hospital stay (days)
8.9
8.9. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 9: Re‐admission to hospital
8.10
8.10. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 10: Nausea
8.11
8.11. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 11: Vomiting
8.12
8.12. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 12: Diarrhoea
8.13
8.13. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 13: Pyrexia
8.14
8.14. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 14: Anxiety score
8.15
8.15. Analysis
Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 15: Depression score
9.1
9.1. Analysis
Comparison 9: Dilatation & Curettage vs Expectant/ Placebo, Outcome 1: Complete Miscarriage
9.2
9.2. Analysis
Comparison 9: Dilatation & Curettage vs Expectant/ Placebo, Outcome 2: Pelvic inflammatory disease, sepsis or endometritis
9.3
9.3. Analysis
Comparison 9: Dilatation & Curettage vs Expectant/ Placebo, Outcome 3: Days of bleeding
10.1
10.1. Analysis
Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 1: Complete Miscarriage
10.2
10.2. Analysis
Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 2: Composite outcome of death or serious complication
10.3
10.3. Analysis
Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 3: Need for unplanned/emergency surgical procedure
10.4
10.4. Analysis
Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 4: Pain score
10.5
10.5. Analysis
Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis
10.6
10.6. Analysis
Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 6: Days of bleeding
10.7
10.7. Analysis
Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 7: Pyrexia
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012602

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Abdelaleem 2020 {published data only}
    1. Abdelaleem MA, Ali MK, Emam S, Abbas AM. Medical versus expectant management in women with incomplete first-trimester miscarriage initially treated with misoprostol: a randomized controlled study. Fertility and Sterility (first received 2020);114(3):e46. [CENTRAL: CN-02193128] [EMBASE: 2008033880]
Al‐Maani 2014 {published data only}
    1. Al-Maani W, Solomayer E, Hammadeh M. Expectant versus surgical management of first-trimester miscarriage: a randomised controlled study. Archives of Gynecology and Obstetrics 2014;289(5):1011-5. - PubMed
Ara 2009 {published data only}
    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.
Arellano 2009 {published data only}
    1. Arellano M, Durocher J, Leon W, Montesinos R, Pena M, Winikoff B. Introduction of misoprostol for incomplete abortion care in Latin America: evidence from Ecuador. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S49. - PubMed
Arif 2018 {published data only}
    1. Arif Butt T, Iqbal A, Saeed M, Ousuf IY, Murtaza A. Outcomes of manual vacuum aspiration versus dilatation and curettage in first trimester miscarriages. Pakistan Journal of Medical and Health Sciences 2018;12(2):611-3.
Bagratee 2004 {published data only}
    1. Bagratee JS, Khullar V, Regan L, Moodley J, Kagoro H. A randomized controlled trial comparing medical and expectant management of first trimester miscarriage. Human Reproduction 2004;19(2):266-71. - PubMed
Bique 2007 {published data only}
    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
Blohm 2005 {published data only}
    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;112(8):1090-5. - PubMed
Braham 2016 {published data only}
    1. Braham R. The use of misoprostol for first time spontaneous abortion. West Indian Medical Journal 2016;65(Suppl 5):74.
Caceres 1979 {published data only}
    1. Caceres EM. Manangement of incomplete abortion: completion by vacuum aspiration and by sharp curettage. Personal communication 1979.
Caceres 1981 {published data only}
    1. Caceres GH, Gamboa GR, Hernandez MA, Escobar GL. Hospital management of incomplete abortion: comparative study of dilation and curettage versus vacuum aspiration [Manejo hospitalario del aborto incompleto: Estudio Comparitivo del curetaje uterino versus la]. Personal communication 1981:1.
Chigbu 2012 {published data only}
    1. Chigbu B, Onwere S, Aluka C, Kamanu C, Ezenobi O. Is misoprostol a suitable alternative to the surgical evacuation of incomplete abortion in rural South-Eastern Nigeria? East African Medical Journal 2012;89(5):172-7. - PubMed
Chipchase 1997 {published data only}
    1. Chipchase J, James D. Randomised trial of expectant versus surgical management of spontaneous miscarriage. British Journal of Obstetrics and Gynaecology 1997;104(7):840-1. - PubMed
Chu 2020 {published data only}
    1. Chu JJ, Devall AJ, Gallos ID, Coomarasamy A, Beeson LE, Hardy P, et al. Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial. Lancet (london, England) 2020 Sep 12;396(10253):770-8. [CENTRAL: CN-02174259] [EMBASE: 2010584315] [PMID: ] - PMC - PubMed
Chung 1997 {published data only}
    1. Chung TK, Cheung LP, Haines CJ. Spontaneous abortion: a randomized controlled trial of misoprostol versus routine surgical evacuation. Acta Obstetricia et Gynecologica Scandinavica 1997;76(167):72. - PubMed
Chung 1999 {published data only}
    1. Chung TK, Cheung LP, Lee D, Haines CJ. Spontaneous abortion: a randomized controlled trial of misoprostol versus routine uterine curettage. British Journal of Obstetrics and Gynaecology 1998;105(Suppl 17):127.
    1. Chung TK, ISRCTN43067169. A randomised, controlled clinical trial involving women who have aborted spontaneously; the health, social and operational costs, outcomes of conservative and routine management. http://www.isrctn.com/ISRCTN43067169 2002.
    1. Chung TK, Lee DT, Cheung LP, Haines CJ, Chang AM. Spontaneous abortion: a randomised controlled trial comparing surgical evacuation with conservative management using misoprostol. Fertility and Sterility 1999;71(6):1054-9. - PubMed
    1. Chung TK, Lee DT. A randomised controlled clinical trial involving women who have aborted spontaneously: the health, social and operational cost outcomes of conservative and routine management protocols. Personal communication 1998.
Dabash 2010 {published data only}
    1. Dabash R, Cherine M, Darwish E, Blum J, Hassanein N, Abdel Daiem T, et al. Bleeding following surgical (MVA) and medical (400 ug sublingual misoprostol) treatment of incomplete abortion. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S150-1.
    1. Dabash R, Ramadan MC, Darwish E, Hassanein N, Blum J, Winikoff B. A randomized controlled trial of 400-mug sublingual misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion in two Egyptian hospitals. International Journal of Gynecology & Obstetrics 2010;111(2):131-5. - PubMed
    1. Ramadan MC. Misoprostol versus MVA for incomplete abortion: results from a randomized controlled trial in Egypt. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S68-9.
Dangalla 2012 {published data only}
    1. Dangalla DP, Goonewardene IM. Surgical treatment versus expectant care in the management of incomplete miscarriage: a randomised controlled trial. Ceylon Medical Journal 2012;57(4):140-5. - PubMed
Dao 2007 {published data only}
    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
Das 2014 {published data only}
    1. Das CM, Sharma M, Pardeep K, Khurshid F. To compare the safety and efficacy of manual vacuum aspiration with misoprostol (ST mom) 600mg in incomplete miscarriage. Journal of the Liaquat University of Medical and Health Sciences 2014;13(3):93-6. [CENTRAL: CN-01086151] [EMBASE: 605161649]
Davis 2007 {published data only}
    1. Davis AR, Hendlish SK, Westhoff C, Frederick MM, Zhang J, Gilles JM, et al. Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial. American Journal of Obstetrics and Gynecology 2007;196(1):31. - PubMed
de Holanda 2003 {published data only}
    1. Holanda AA, dos Santos HP, Barbosa MF, Barreto CF, Felinto AS, Araujo IA. Treatment of miscarriage in the first trimester of pregnancy: curettage versus manual vacuum aspiration [Tratamento do abortamento do primeiro trimestre da gestacao: curetagem versus aspiracao manual a vacuo]. Revista Brasileira de Ginecologia e Obstetricia 2003;25(4):271-6.
de Jonge 1995 {published data only}
    1. Jonge ET, Makin JD, Manefeldt E, De Wet GH, Pattinson RC. Randomised clinical trial of medical evacuation and surgical curettage for incomplete miscarriage. BMJ 1995;311(7006):662. - PMC - PubMed
Demetroulis 2001 {published data only}
    1. Demetroulis C, Saridogan E, Kunde D, Naftalin AA. A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure. Human Reproduction 2001;16(2):365-9. - PubMed
    1. Demetroulis C, Saridogan E, Kunde D, Naftalin AA. A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure [abstract]. XVI FIGO World Congress of Obstetrics & Gynecology; 2000 Sept 3-8; Washington DC, USA 2000;Book 3:69. - PubMed
Fernlund 2018 {published data only}
    1. Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L. A randomised controlled trial comparing misoprostol to expectant care in early pregnancy failure. Ultrasound in Obstetrics & Gynecology 2017;50(Suppl 1):15, Abstract no: OC08.03.
    1. Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L. Misoprostol treatment vs expectant management in women with early non-viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial. Ultrasound in Obstetrics & Gynecology 2018;51(1):24-32. - PubMed
    1. Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L. Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding. Archives of Gynecology and Obstetrics 2020 Jul 7;302(5). [CENTRAL: CN-02140210] [EMBASE: 2005498459] [PMID: ] - PMC - PubMed
    1. Valentin L. Which is the optimal treatment for miscarriage with a gestational sac in the uterus and which factors can predict if the treatment will be successful? clinicaltrials.gov/ct2/show/NCT01033903 (first received: 16 December 2009).
Fonseca 1997 {published data only}
    1. Fonseca W, Misago C, Fernandes L, Correia L, Silveira D. Use of manual vacuum aspiration in reducing cost and duration of hospitalization due to incomplete abortion in an urban area of northeastern brazil [Uso da aspiracao manual a vacuo na reducao do custo e duracao de internamentos por aborto incompleto em fortaleza, CE, Brasil]. Revista de Saude Publica 1997;31(5):472-8. - PubMed
Ganguly 2010 {published data only}
    1. Ganguly RP, Mukhopadhyay S, Burman SK, Patra KK, Jha T, Mukherji J. A randomized trial of misoprostol compared with manual vacuum aspiration for early pregnancy failure. Nepal Journal of Obstetrics and Gynaecology 2010;5(2):8-13.
Gazvani 2000 {published data only}
    1. Gazvani R, Templeton A. A pilot study for the use of manual vacuum aspiration in early pregnancy loss. Journal of Obstetrics and Gynaecology 2000;20(1):105.
Graziosi 2004 {published data only}
    1. Graziosi GC, Bruinse HW, Reuwer PJH, Kessel PH, Westerweel PE, Mol BW. Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality life. A randomized controlled trial. Human Reproduction 2005;20(8):2340-7. - PubMed
    1. Graziosi GC, Steeg JW, Reuwer PH, Drogtrop AP, Bruinse HW, Mol BW. Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management. Human Reproduction 2005;20(4):1067-71. - PubMed
    1. Graziosi GCM, Mol BW, Reuwer PJH, Drogtrop A, Bruinse HW. Misoprostol versus curettage in women with early pregnancy failure after initial expectant management: a randomized trial. Human Reproduction 2004;19(8):1894-9. - PubMed
Hamel 2021 {published data only}
    1. Hamel C, Coppus S, den Berg J, Hink E, Seeters J, Kesteren P, et al. Mifepristone followed by misoprostol compared with placebo followed by misoprostol as medical treatment for early pregnancy loss (the TripleM trial): A double-blind placebo-controlled randomised trial. EClinicalMedicine 2021:https://doi.org/10.1016/j.eclinm.2020.100716. - PMC - PubMed
    1. den Berg J, Hamel CC, Snijders MP, Coppus SF, Vandenbussche FP. Mifepristone and misoprostol versus misoprostol alone for uterine evacuation after early pregnancy failure: study protocol for a randomized double blinded placebo-controlled comparison (Triple M Trial). BMC Pregnancy and Childbirth 2019;19(1):443. [CENTRAL: CN-02012095] [EMBASE: 630004464] [PMID: ] - PMC - PubMed
Harwood 2008 {published data only}
    1. Harwood B, Nansel T, for theNIofCHandHDMofEPFT. 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
Ibiyemi 2018 {published data only}
    1. Ibiyemi K F, Ijaiya M A, Adesina KT. Randomised trial of oral misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion at a Nigerian Tertiary Unit. Sultan Qaboos University Medical Journal 2019;19:38-43. - PMC - PubMed
    1. Ibiyemi KF, PACTR201803003087264. Randomised trial of oral misoprostol versus manual vacuum aspiration for treatment of incomplete abortion in a Nigerian Tertiary hospital. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3087 2018. - PMC - PubMed
Igogo 2015 {published data only}
    1. Igogo P, Karanja J, Kamau K, Tamooh H. Use of misoprostol for incomplete abortion in resource-poor settings. Contraception 2015;92(4):370.
Kaluaarachchi 2015 {published data only}
    1. Kaluaarachchi A, Kopalakrishnan M. Surgical, medical or expectant management of first trimester miscarriage and its implications on clinical and psychological outcomes –a randomized controlled trial. Sri Lanka Journal of Obstetrics and Gynaecology 2015;37(Suppl 1):17, Abstract no: OP 39.
Karlsen 2001 {published data only}
    1. Karlsen JH, Schiotz HA. Curettage or not after spontaneous abortion? [Norwegian] [Utskrapning eller ikke etter spontanabort?]. Tidsskrift for Den Norske Laegeforening 2001;121(24):2812-4. - PubMed
Kashif 2020 {published data only}
    1. Kashif A, Faisal J, Jawad Z, Inayat FC, Shabana N, Kanwal S. Comparison of vaginal misoprostol with suction evacuation for the management of first trimester spontaneous miscarriage. Pakistan Journal of Medical and Health Sciences 2020;14(2):517-21. [CENTRAL: CN-02193578] [EMBASE: 2007799407]
Kittiwatanakul 2012 {published data only}
    1. Kittiwatanakul W, Weerakiet S. Comparison of efficacy of modified electric vacuum aspiration with sharp curettage for the treatment of incomplete abortion: randomized controlled trial. Journal of Obstetrics and Gynaecology Research 2012;38(4):681-5. - PubMed
Kong 2013 {published data only}
    1. Kong GW, Lok IH, Yiu AK, Hui AS, Lai BP, Chung TK. Clinical and psychological impact after surgical, medical or expectant management of first-trimester miscarriage - a randomised controlled trial. Australian & New Zealand Journal of Obstetrics & Gynaecology 2013;53(2):170-7. - PubMed
Kovavisarach 2002 {published data only}
    1. Kovavisarach E, Sathapanachai U. Intravaginal 400 micrograms misoprostol for pregnancy termination in cases of blighted ovum: a randomised controlled trial. Australian & New Zealand Journal of Obstetrics and Gynaecology 2002;42(2):161-3. - PubMed
    1. Sathapanachai U. Intravaginal 400 micrograms misoprostol for pregnancy termination in cases of blighted ovum. Thai Journal of Obstetrics and Gynaecology 2000;12(4):363. - PubMed
Kyaw 2015 {published data only}
    1. Kyaw O, Yi KH, Thida M. A comparison of medical evacuation using single dose vaginal misoprostol (800mug) versus surgical evacuation in management of early pregnancy loss in North Okkalapa General and Teaching Hospital, Yangon. Journal of Obstetrics and Gynaecology Research 2015;41:3, Abstract no: YGA O 06.
Lee 2001 {published data only}
    1. Lee DT, Cheung LP, Haines CJ, Chan KP, Chung TK. A comparison of the psychologic impact and client satisfaction of surgical treatment with medical treatment of spontaneous abortion: a randomized controlled trial. American Journal of Obstetrics and Gynecology 2001;185:953-8. - PubMed
Lister 2005 {published data only}
    1. Lister MS, Shaffer LE, Bell JG, Lutter KQ, Moorma KH. Randomized, double-blind, placebo-controlled trial of vaginal misoprostol for management of early pregnancy failures. American Journal of Obstetrics and Gynecology 2005;193:1338-43. - PubMed
Machtinger 2002 {published data only}
    1. Machtinger R, Stockheim D, Goldenberg M, Soriano D, Atlas M, Seidman DS. A randomized prospective study of misoprostol alone or combined with mifepristone for treatment of first trimester spontaneous abortion [abstract]. Fertility and Sterility 2002;78(3 Suppl 1):S64.
Machtinger 2004 {published data only}
    1. Machtinger R, Stockheim D, Shulman A, Dulitzki M, Schiff E, Seidman DS. A randomized prospective study comparing the effectiveness of four protocols for treatment of first trimester spontaneous abortion [abstract]. Fertility and Sterility 2004;82 Suppl 2:S80.
Montesinos 2011 {published data only}
    1. Montesinos R, Durocher J, Leon W, Arellano M, Pena M, Pinto E, et al. Oral misoprostol for the management of incomplete abortion in Ecuador. International Journal of Gynecology & Obstetrics 2011;115(2):135-9. - PubMed
    1. NCT00674232. Misoprostol for treatment of incomplete abortion. https://clinicaltrials.gov/ct2/show/NCT00674232 2008.
Moodliar 2005 {published data only}
    1. Moodliar S, Bagratee JS, Moodley J. Medical vs. surgical evacuation of first-trimester spontaneous abortion. International Journal of Gynecology & Obstetrics 2005;91:21-6. - PubMed
Muffley 2002 {published data only}
    1. Muffley PE, Stitely ML, Gherman RB. Early intrauterine pregnancy failure: a randomized trial of medical versus surgical treatment. American Journal of Obstetrics and Gynecology 2002;187:321-6. - PubMed
Nadarajah 2014 {published data only}
    1. Nadarajah R, Quek YS, Kuppannan K, Woon SY, Jeganathan R. A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss. European Journal of Obstetrics, Gynecology and Reproductive Biology 2014;178:35-41. - PubMed
    1. Quek YS, Woon SY, Ravichandran N, Ravichandran J. A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss. BJOG: an international journal of obstetrics and gynaecology 2012;119(Suppl 1):218. - PubMed
Nasreen 2009 {published data only}
    1. Nasreen Z. What for early pregnancy failure manual vacuum aspiration (MVA) with small dose misoprostol or misoprostol alone? International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S539-40.
Ngai 2001 {published data only}
    1. Ngai SW, Chan YM, Tang OS, Ho PC. Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage. Human Reproduction 2001;16(7):1493-6. - PubMed
Nielsen 1995 {published data only}
    1. Nielsen S, Hahlin M, Moller A, Granberg S. Bereavement, grieving and psychological morbidity after first trimester spontaneous abortion: comparing expectant management with surgical evacuation. Human Reproduction 1996;11(8):1767-70. - PubMed
    1. Nielsen S, Hahlin M. Expectant management of first-trimester spontaneous abortion [see comments]. Lancet 1995;345(8942):84-6. - PubMed
Nielsen 1999 {published data only}
    1. Nielsen S, Hahlin M, Platz-Christensen J. Expectant management or pharmacological treatment for first trimester spontaneous abortion: a randomised trial. Acta Obstetricia et Gynecologica Scandinavica 1997;76(167):77.
    1. Nielsen S, Hahlin M, Platz-Christensen J. Randomised trial comparing expectant with medical management for first trimester miscarriages. British Journal of Obstetrics and Gynaecology 1999;106(8):804-7. - PubMed
    1. Nielsen S, Hahlin M. Expectant management of first-trimester miscarriage. In: Grundzinkas JG, editors(s). Problems in Early Pregnancy - Advances in Diagnosis and Management. London: RCOG, 1997:265-76.
Niinimaki 2006 {published data only}
    1. Niinimaki M, Jouppila P, Martikainen H, Talvensaari-Mattila A. A randomized study comparing efficacy and patient satisfaction in medical or surgical treatment of miscarriage. Fertility and Sterility 2006;86(2):367-72. - PubMed
    1. Niinimaki M, Karinen P, Hartikainen AL, Pouta A. Treating miscarriages: a randomised study of cost-effectiveness in medical or surgical choice. BJOG: an international journal of obstetrics and gynaecology 2009;116(7):984-90. - PubMed
Nwafor 2020 {published data only}
    1. Nwafor JI, Agwu UM, Egbuji CC, Ekwedigwe KC. Misoprostol versus manual vacuum aspiration for treatment of first-trimester incomplete miscarriage in a low-resource setting: a randomized controlled trial. Nigerian Journal of Clinical Practice 2020 May;23(5):638-46. [CENTRAL: CN-02122567] [EMBASE: 631677586] [PMID: ] - PubMed
Patua 2013 {published data only}
    1. Patua B, Dasgupta M, Bhattacharyya SK, Bhattacharya S, Hasan SH, Saha S. An approach to evaluate the efficacy of vaginal misoprostol administered for a rapid management of first trimester spontaneous onset incomplete abortion, in comparison to surgical curettage. Archives of Gynecology and Obstetrics 2013;288(6):1243-8. - PubMed
Pereira 2006 {published data only}
    1. Pereira PP, Oliveira AL, Cabar FR, Armelin AR, Maganha CA, Zugaib M. Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion. Revista Da Associacao Medica Brasileira 2006;52(5):304-7. - PubMed
Phusaanantakul 2010 {published data only}
    1. Phusaanantakul P, Promsonthi P, Chanrachakul B. Effect of isosorbide mononitrate for cervical ripening before surgical termination of pregnancy in the first trimester. International Journal of Gynecology & Obstetrics 2010;110(2):145-8. - PubMed
Sahin 2001 {published data only}
    1. Sahin HG, Sahin HA, Kocer M. Randomized outpatient clinical trial of medical evacuation and surgical curettage in incomplete miscarriage. European Journal of Contraception & Reproductive Health Care 2001;6(3):141-4. - PubMed
Salam 2016 {published data only}
    1. Salam R, Neelofer R, Naserullah P. Comparative study of manual vacuum aspiration and dilatation & evacuation for the surgical management of early miscarriages: a randomized controlled trial. Pakistan Journal of Medical and Health Sciences 2016;10(1):183-5.
Schreiber 2018 {published data only}
    1. Flynn AN, Roe AH, Koelper N, McAllister A, Sammel MD, Schreiber CA. Timing and efficacy of mifepristone pretreatment for medical management of early pregnancy loss. Contraception 2021;103(6):404-7. [CENTRAL: CN-02218404] [EMBASE: 2010804683] [PMID: ] - PMC - PubMed
    1. Nagendra D, Koelper N, Loza-Avalos SE, Sonalkar S, Chen M, Atrio J, et al. Cost-effectiveness of mifepristone pretreatment for the medical management of nonviable early pregnancy: secondary analysis of a randomized clinical trial. JAMA Network Open 2020 Mar 02;3(3):e201594. [CENTRAL: CN-02100126] [EMBASE: 631375356] [PMID: ] - PMC - PubMed
    1. Nagendra D, Schreiber CA, Koelper N, Sonalkar S, Loza-Avalos S, Harvie H. Cost effectiveness of mifepristone pretreatment for the medical management of nonviable early pregnancy. Obstetrics and Gynecology 2019;133(Suppl 1):6. [EMBASE: L633843717] - PMC - PubMed
    1. NCT02012491. Comparative effectiveness of pregnancy failure management regimens. Https://clinicaltrials.gov/show/nct02012491 2013.
    1. Schreiber CA, Sonalkar S, Barnhart KT, Ratcliffe SJ, Creinin MD, Atrio J. Mifepristone pretreatment for the medical management of early pregnancy loss. New England Journal of Medicine 2018;378(23):2161-70. - PMC - PubMed
Schwarzler 2003 {published data only}
    1. Schwarzler P. The conservative management of first trimester miscarriages and the use of sonography for patients' selection [abstract]. Ultrasound in Obstetrics & Gynecology 2003;22(Suppl 1):4.
Shaheen 2017 {published data only}
    1. Shaheen H, Khosa MS, Hanif H. Comparison of efficacy of manual vacuum aspiration (MVA) and medical treatment in the management of first trimester missed miscarriage. Pakistan Journal of Medical and Health Sciences 2017;11(1):270-3.
Shaikh 2008 {published data only}
    1. Shaikh ZA. Comparison between misoprostol alone and misoprostol with manual vacuum aspiration for the treatment of missed and incomplete miscarriage. BJOG: an international journal of obstetrics and gynaecology 2008;115(s1):83.
Shelley 2005 {published data only}
    1. Shelley JM, Healy D, Grover S. A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage. Australian and New Zealand Journal of Obstetrics and Gynaecology 2005;45:122-7. - PubMed
Shuaib 2013 {published data only}
    1. Shuaib AA, Alharazi AH. Medical versus surgical termination of the first trimester missed miscarriage. Alexandria Journal of Medicine 2013;49:13-6.
Shwekerela 2007 {published data only}
    1. Shwekerela B, Kalumuna R, Kipingili R, Mashaka N, Westheimer E, Clark W, et al. Misoprostol for treatment of incomplete abortion at the regional hospital level: results from Tanzania. BJOG: an international journal of obstetrics and gynaecology 2007;114(11):1363-7. - PubMed
Sinha 2018 {published data only}
    1. Sinha P, Suneja A, Guleria K, Aggarwal R, Vaid NB. Comparison of mifepristone followed by misoprostol with misoprostol alone for treatment of early pregnancy failure: a randomized double-blind placebo-controlled trial. Journal of Obstetrics and Gynecology of India 2018;68(1):39-44. - PMC - PubMed
Stockheim 2006 {published data only}
    1. Stockheim D, Machtinger R, Wiser A, Dulitzky M, Soriano D, Goldenberg M, et al. A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure. Fertility and Sterility 2006;86(4):956-60. - PubMed
Tationo 2012 {published data only}
    1. Tationo SH, Ravichandran J, Othman MS. Manual vacuum aspirator versus surgical curettage for surgical treatment of first trimester incomplete miscarriage. BJOG: an international journal of obstetrics and gynaecology 2012;119(Suppl 1):198.
Taylor 2011 {published data only}
    1. Taylor J, Diop A, Blum J, Dolo O, Winikoff B. Oral misoprostol as an alternative to surgical management for incomplete abortion in Ghana. International Journal of Gynecology & Obstetrics 2011;112(1):40-4. - PubMed
Torre 2012 {published data only}
    1. Rosenberg P//NCT00190294. Comparison expectant with immediate medical management for the evacuation of the no evolutionary pregnancies before 13 GW. clinicaltrials.gov/ct2/show/record/NCT00190294 2006.
    1. Torre A, Huchon C, Bussieres L, Machevin E, Camus E, Fauconnier A. Immediate versus delayed medical treatment for first-trimester miscarriage: a randomized trial. American Journal of Obstetrics & Gynecology 2012;206(3):215.e1-6. - PubMed
Trinder 2006 {published data only}
    1. Petrou S, Trinder J, Brocklehurst P, Smith L. Economic evaluation of alternative management methods of first-trimester miscarriage based on results from the MIST trial. BJOG: an international journal of obstetrics and gynaecology 2006;113(8):879-89. - PubMed
    1. Smith L, ISRCTN66418282. Randomised controlled trial of expectant, medical and surgical management of early miscarriage. http://www.isrctn.com/ISRCTN66418282 2004.
    1. Smith L. Extension to: randomised controlled trial of expectant, medical and surgical management of early miscarriage. Research Findings Register (www.refer.nhs.uk) (accessed 7 March 2006) 2006.
    1. Smith LF, Ewings PD, Quinlan C. Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial. BMJ 2009;339:b3827. - PMC - PubMed
    1. Smith LF, Frost J, Levitas R, Bradley H, Garcia J. Women's experiences of three early miscarriage management options: a qualitative study. British Journal of General Practice 2006;56(524):198-205. - PMC - PubMed
Ulstrup 1997 {published data only}
    1. Ulstrup KS, Lopez HB, Mogensen H, Blaakaer J. Treatment of early spontaneous abortion. Evacuation or expectation? Acta Obstetricia et Gynecologica Scandinavica 1997;76 Suppl(167:1):78.
Verkuyl 1993 {published data only}
    1. Verkuyl DA, Crowther CA. Suction v. conventional curettage in incomplete abortion. A randomised controlled trial [see comments]. South African Medical Journal 1993;83:13-5. - PubMed
Weeks 2005 {published data only}
    1. Weeks A, Alia G, Blum J, Blanchard K, Winikoff B. A randomised trial of oral misoprostol (600mcg) versus manual vacuum aspiration in the treatment of incomplete miscarriage in Kampala, Uganda. In: 30th British Congress of Obstetrics and Gynaecology; 2004 July 7-9; Glasgow, UK. 2004:27.
    1. Weeks A, Alia G, Blum J, Winikoff B, Ekwaru P, Durocher J, et al. A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion. Obstetrics & Gynecology 2005;106(3):540-7. - PubMed
Wijesinghe 2011 {published data only}
    1. Padumadasa S, SLCTR/2008/012. Efficacy of surgical versus expectant management in incomplete miscarriage. https://slctr.lk/trials/slctr-2008-012 2008.
    1. Wijesinghe PS, Padumadasa GS, Palihawadana TS, Marleen FS. A trial of expectant management in incomplete miscarriage. Ceylon Medical Journal 2011;56(1):10-3. - PubMed
Wood 2002 {published data only}
    1. Wood SL, Brain PH. Medical management of missed abortion: a randomized clinical trial. Obstetrics & Gynecology 2002;99(4):563-6. - PubMed
Zhang 2005 {published data only}
    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 & Gynecology 2008;198(6):626.e1-5. - PMC - PubMed
    1. 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
    1. Edwards S, Tureck R, Fredrick M, Huang X, Zhang J, Barnhart K. Patient acceptability of manual versus electric vacuum aspiration for early pregnancy loss. Journal of Women's Health 2007;16(10):1429-36. - PubMed
    1. Rausch M, Lorch S, Chung K, Frederick M, Zhang J, Barnhart K. A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss. Fertility and Sterility 2012;97(2):355-60.e1. - PMC - PubMed
    1. Reeves MF, Lohr PA, Harwood B, Creinin MD. Sonographic findings after misoprostol or vacuum aspiration for early pregnancy failure. Contraception 2006;74(2):182. - PubMed

References to studies excluded from this review

Abbasalizadeh 2018 {published data only}
    1. Abbasalizadeh F, IRCT2014030114293N1. Comparison the effect of letrozole plus Misoprostol and misoprostol alone in termination of nonviable first trimester pregnancies; a single blinded randomized trial. http://en.irct.ir/trial/13912 2014. - PMC - PubMed
    1. Abbasalizadeh F, Sahhaf F, Sadeghi-Shabestari P, Mirza-Aghazadeh-Attari M, Naghavi-Behzad M. Comparison between effect of letrozole plus misoprostol and misoprostol alone in terminating non-viable first trimester pregnancies: a single blind randomized trial. Journal of Family and Reproductive Health 2018;12(1):27-33. - PMC - PubMed
Abdel Fattah 1997 {published data only}
    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.
Abd‐El‐Maeboud 2012 {published data only}
    1. Abd-El-Maeboud KH, Ghazy A, Ibrahim A, Hassan N, El-Bohoty A, Gamal-El-Din I. Vaginal acidity enhancement with a 3% acetic acid gel prior to misoprostol treatment for pregnancy termination in the midtrimester. International Journal of Gynecology and Obstetrics 2012;119(3):248-52. - PubMed
Abdelshafy 2019a {published data only}
    1. Abdelshafy A, Awwad H, Abo-Gamra A, Alanwar A, Elkotb AM, Shahin M, et al. Sublingual vs vaginal misoprostol for completion of first trimester missed abortion: a randomised controlled trial. European Journal of Contraception and Reproductive Health Care 2019;24(2):134-9. - PubMed
    1. El Shahawy A, NCT02686840. Sublingual versus vaginal misoprostol in medical treatment of first trimestric missed miscarriage: a randomized controlled trial. https://clinicaltrials.gov/ct2/show/NCT02686840 (22 February 2016).
Abediasl 2016 {published data only}
    1. Abediasl Z, Sheikh M, Pooransari P, Farahani Z, Kalani F. Vaginal misoprostol versus intravenous oxytocin for the management of second-trimester pregnancies with intrauterine fetal death: a randomized clinical trial. Journal of Obstetrics and Gynaecology Research 2016;42(3):246-51. - PubMed
Abeysundara 2012 {published data only}
    1. Abeysundara ID, Herath RP, Wijesinghe PS. A qualitative study on patients' perceptions of expectant management of incomplete miscarriage. BJOG: an international journal of obstetrics and gynaecology 2012;119(Suppl 1):150. - PubMed
Ajand 2017 {published data only}
    1. Ajand M, IRCT201704179014N159. Comparison of the effect of vaginal versus sublingual misoprostol in medical induction of missed abortions: a randomized clinical trial. http://en.irct.ir/trial/9597 2017.
Al 2003 {published data only}
    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
Al‐Bdour 2007 {published data only}
    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.
Ali 2015 {published data only}
    1. Ali MK, NCT02573051. Misoprostol plus isosorbide mononitrate versus misoprostol for termination of anembryonic pregnancy. https://clinicaltrials.gov/ct2/show/NCT02573051 2015.
Ali 2017 {published data only}
    1. Ali MK, NCT03148314. Home-based extended low dose buccal misoprostol versus hospital-based standard vaginal dose in management of first trimester missed abortion. https://clinicaltrials.gov/ct2/show/NCT03148314 (11 May 2017).
Allameh 2020 {published data only}
    1. Allameh Z, Goharian M, Eslamian M. Effect of misoprostol with and without letrozole on induction of abortion for women with first-trimester missed abortion. International Journal of Gynaecology and Obstetrics 2020 Jul 22;151(2):214-8. [CENTRAL: CN-02137849] [EMBASE: 2006040208] [PMID: ] - PubMed
Almog 2005 {published data only}
    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
Altaf 2006 {published data only}
    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.
Ameen 2009 {published data only}
    1. Ameen NS, NCT00892229. Buccal versus vaginal misoprostol for cervical ripening prior to surgical termination of the first trimester missed abortion in Erbil. https://clinicaltrials.gov/ct2/show/NCT00892229 2009.
Amjad 1999 {published data only}
    1. Amjad T, Akhtar S. Termination of pregnancy with foetal death in second trimester: Foley's catheter versus extra amniotic prostaglandins. Journal of the College of Physicians & Surgeons Pakistan 1999;9:403-5.
Anderman 2000 {published data only}
    1. Anderman S, Jaschevatzky OE, Ballas S. Comparison between a double balloon device and the Foley catheter in extraamniotic prostaglandin F2a infusion for termination of midtrimester missed abortion [abstract]. In: XVI FIGO World Congress of Obstetrics & Gynecology (Book 2); 2000 Sept 3-8; Washington DC, USA. 2000:161.
Anderson 2009 {published data only}
    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. Gouk E, ISRCTN85124072. Oral versus vaginal misoprostol for medical management of early foetal demise. http://www.isrctn.com/ISRCTN85124072 2009.
Aramide 2014 {published data only}
    1. Aramide TM, Olusegun AK, Akinfolarin AC, Oriola DF. Oral misoprostol in the prevention of uterine bleeding after surgical evacuation of first trimester abortion: a comparative study of three uterotonic agents. Nigerian Journal of Clinical Practice 2014 Jan-Feb;17(1):10-3. [CENTRAL: CN-00982541] [PMID: ] - PubMed
Arteaga‐Troncoso 2005 {published data only}
    1. Arteaga-Troncoso G, Villegas-Alvarado A, Belmont-Gomez A, Martinez-Herrera FJ, Villagrana-Zesati R, Guerra-Infante F. Intracervical application of the nitric oxide donor isosorbide dinitrate for induction of cervical ripening: a randomised controlled trial to determine clinical efficacy and safety prior to first trimester surgical evacuation of retained products of conception. BJOG: an international journal of obstetrics and gynaecology 2005;112(12):1615-9. - PubMed
Autry 1999 {published data only}
    1. Autry A, Jacobson G, Sandhu R, Isbill K. Medical management of non-viable early first trimester pregnancy. International Journal of Gynecology & Obstetrics 1999;67(1):9-13. - PubMed
Avila‐Vergara 1997 {published data only}
    1. Avila-Vergara MA, Morgan-Ortiz F, Fragoza-Sosa O, Haro-Garcia L. [Cervical labor induction with prostaglandin E2 in patients with fetal death] [Maduracion cervical con prostaglandina E2 en pacientes con feto muerto]. Ginecologia y Obstetricia de Mexico 1997;65:155-8. - PubMed
Avila VergaraMa 1997 {published data only}
    1. Avila-Vergara Ma, Morgan-Ortiz F Fragoza-Sosa O Haro-Garcia L. [Cervical labor induction with prostaglandin E2 in patients with fetal death]. Ginecologia y Obstetricia de Mexico 1997;65:155-8. - PubMed
Aye 2017 {published data only}
    1. Aye TT, Aung KL, Myint SS. A comparative study on effect of sublingual versus vaginal misoprostol in management of first trimester miscarriage in Magway Teaching Hospital. Journal of Obstetrics and Gynaecology Research 2017;43:185-6, Abstract no: 9020 https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/jog.13396.
Ayudhaya 2006 {published data only}
    1. Ayudhaya OP, Herabutya Y, Chanrachakul B, Ayuthaya NI, O-Prasertsawat P. A comparison of the efficacy of sublingual and oral misoprostol 400 microgram in the management of early pregnancy failure: a randomized controlled trial. Journal of the Medical Association of Thailand 2006;89(Suppl 4):S5-S10. - PubMed
Azra 2007 {published data only}
    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.
Bagratee 2009 {published data only}
    1. Bagratee J, Regan L, Khullar V, Moodley J, Connolly C. Does the volume of retained products of conception and hormonal parameters influence the success of conservative methods of management of first trimester miscarriage? International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S116.
Bani‐Irshaid 2006 {published data only}
    1. Bani-Irshaid I, Athamneh TZ, Bani-Khaled D, Al-Momani M, Dahamsheh H. Termination of second and early third trimester pregnancy: comparison of 3 methods. Eastern Mediterranean Health Journal 2006;12(5):605-9. - PubMed
Barnhart 2004 {published data only}
    1. Barnhart KT, Bader T, Huang X, Frederick MM, Timbers KA, Zhang JJ. Hormone pattern after misoprostol administration for a nonviable first-trimester gestation. Fertility and Sterility 2004;81(4):1099-105. - PubMed
Bartz 2013 {published data only}
    1. Bartz D, Maurer R, Allen RH, Fortin J, Kuang B, Goldberg AB. Buccal misoprostol compared with synthetic osmotic cervical dilator before surgical abortion: a randomized controlled trial. Obstetrics and Gynecology 2013;122(1):57-63. - PubMed
Bebbington 2002 {published data only}
    1. Bebbington MW, Kent N, Lim K, Gagnon A, Delisle MF, Tessier F, et al. A randomized controlled trial comparing two protocols for the use of misoprostol in midtrimester pregnancy termination. American Journal of Obstetrics and Gynecology 2002;187(4):853-7. - PubMed
Behrashi 2008 {published data only}
    1. Behrashi M, Mahdian M. Vaginal versus oral misoprostol for second-trimester pregnancy termination: a randomized trial. Pakistan Journal of Biological Sciences 2008;11(21):2505-8. - PubMed
    1. Behrashi M. Comparison between the oral and vaginal misoprostol effects on pregnancy termination in second trimester. en.search.irct.ir/view/90 (first received 27 September 2008).
Ben‐Meir 2009 {published data only}
    1. Ben-Meir A, Erez Y, Feigenberg T, Hamani Y, Laufer N, Rojansky N. Mifepristone followed by high-dose oxytocin drip for second-trimester abortion: a randomized, double-blind, placebo-controlled, pilot study. Journal of Reproductive Medicine 2009;54(8):511-6. - PubMed
Betstadt 2008 {published data only}
    1. Betstadt S//NCT00468299. MiMi: a randomized trial of mifepristone and misoprostol for treatment of early pregnancy failure. clinicaltrials.gov/ct2/show/NCT00468299 (first received 1 May 2007).
    1. Betstadt S. MiMi: a randomized trial of mifepristone and misoprostol for treatment of early pregnancy failure. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 20 February 2008) 2008.
Biswas 2007 {published data only}
    1. Biswas SC, Dey R, Jana R, Chattopadhyay N. Comparative study of intravaginal misoprostol and extra amniotic ethacridine lactate instillation for mid trimester pregnancy termination. Journal of Obstetrics and Gynaecology of India 2007;57(3):211-3.
Blanchard 2004 {published data only}
    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
Blohm 1997 {published data only}
    1. Blohm F, Hahlin M, Nielsen S, Milsom I. Fertility after a randomised trial of spontaneous abortion managed by surgical evacuation or expectant treatment [letter]. Lancet 1997;349(9057):995. - PubMed
Bracken 2014 {published data only}
    1. Bracken H, Ngoc NT, Banks E, Blumenthal P, Derman R, Patel A, et al. Misoprostol for treatment of intrauterine fetal death at 14-28 weeks of pregnancy. American Journal of Obstetrics and Gynecology 2013;208(1 Suppl):S62-S63.
    1. Bracken H, Ngoc NT, Banks E, Blumenthal PD, Derman RJ, Patel A, et al. Buccal misoprostol for treatment of fetal death at 14-28 weeks of pregnancy: a double-blind randomized controlled trial. Contraception 2014;89(3):187-92. - PubMed
Bracken 2019 {published data only}
    1. Bracken H, Zuberi N, Guevara Puerto AL, Mayi-Tsonga S, Buendia Gomez M, Irfan Ahmed S, et al. Mifepristone and sublingual misoprostol versus sublingual misoprostol alone for missed abortion: results of a randomized placebo-controlled trial. Contraception 2019 May;99(5):315-6. [CENTRAL: CN-01937106] [EMBASE: 2001888624]
Brouns 2010 {published data only}
    1. Brouns JF, Wely M, Burger MP, Wijngaarden WJ. Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination. Contraception 2010;82(3):266-75. - PubMed
Cabrol 1990 {published data only}
    1. Cabrol D, Dubois C, Cronje H, Gonnet JM, Guillot M, Maria B, et al. Induction of labor with mifepristone (RU 486) in intrauterine fetal death. American Journal of Obstetrics and Gynecology 1990;163:540-2. - PubMed
Caliskan 2005 {published data only}
    1. Caliskan E, Dilbaz S, Doger E, Ozeren S, Dilbaz B. Randomized comparison of 3 misoprostol protocols for abortion induction at 13-20 weeks of gestation. Journal of Reproductive Medicine 2005;50(3):173-80. - PubMed
Caliskan 2009 {published data only}
    1. Caliskan E, Doger E, Cakiroglu Y, Corakci A, Yucesoy I. Sublingual misoprostol 100 microgram versus 200 microgram for second trimester abortion: a randomised trial. European Journal of Contraception & Reproductive Health Care 2009;14(1):55-60. - PubMed
Chen 2008a {published data only}
    1. Chen FC, Bergann A, Krosse J, Merholz A, David M. Isosorbide mononitrate vaginal gel versus misoprostol vaginal gel versus Dilapan-S for cervical ripening before first trimester curettage. European Journal of Obstetrics & Gynecology and Reproductive Biology 2008;138(2):176-9. - PubMed
Chittacharoen 2003 {published data only}
    1. Chittacharoen A, Herabutya Y, Punyavachira P. A randomized trial of oral and vaginal misoprostol to manage delivery in cases of fetal death. Obstetrics & Gynecology 2003;101:70-3. - PubMed
Chowdhury 2012 {published data only}
    1. Chowdhury S, Uddin AW. Misoprostol in the management of second trimester missed abortion: a randomized controlled trial. International Journal of Gynaecology and Obstetrics 2012;119(Suppl 3):S310.
Cleeve 2016 {published data only}
    1. Cleeve A, Byamugisha J, Gemzell-Danielsson K, Mbona Tumwesigye N, Atuhairwe S, Faxelid E, et al. Women's acceptability of misoprostol treatment for incomplete abortion by midwives and physicians - a randomized controlled equivalence trial at district level, Uganda. International Journal of Gynecology and Obstetrics 2015;131(Suppl 5):E295. - PMC - PubMed
    1. Cleeve A, Byamugisha J, Gemzell-Danielsson K, Tumwesigye NM, Atuhairwe S, Faxelid E, et al. Women's acceptability of misoprostol treatment for incomplete abortion by midwives and physicians - Secondary outcome analysis from a randomized controlled equivalence trial at district level in Uganda. PloS One 2016;11(2):e0149172. - PMC - PubMed
Clevin 2001 {published data only}
    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
Creinin 1997 {published data only}
    1. Creinin MD, Moyer R, Guido R. Misoprostol for medical evacuation of early pregnancy failure. Obstetrics & Gynecology 1997;89:768-72. - PubMed
Creinin 2004 {published data only}
    1. Creinin MD, Harwood B, Guido RS, Fox MC, Zhang J, NICHD Management of Early Pregnancy Failure Trial. Endometrial thickness after misoprostol use for early pregnancy failure. International Journal of Gynaecology & Obstetrics 2004;86(1):22-6. - PMC - PubMed
Cruz 2017 {published data only}
    1. Cruz RP, Scheffler MH, da Silva DM, Guedes Neto EP, Savaris RF. Moistening the new vaginal misoprostol tablets: does it increase the efficacy of cervical priming before manual vacuum aspiration in first-trimester miscarriage? A randomised clinical trial. European Journal of Contraception & Reproductive Health Care 2017;22(6):407-11. - PubMed
Danielsson 2012 {published data only}
    1. Danielsson KG, NCT01615224. Repeated doses of misoprostol for treatment of missed abortion. https://clinicaltrials.gov/ct2/show/NCT01615224 2012.
David 2003 {published data only}
    1. David M, Chen FC, Lichtenegger W. NO-donor nitroglycerin versus the prostaglandin gemeprost for cervical ripening in first trimester missed abortion. International Journal of Gynecology & Obstetrics 2003;83:71-2. - PubMed
David 2005 {published data only}
    1. David M, Chen FC. Comparison of isosorbide mononitrate (Mono Mack) and misoprostol (Cytotec) for cervical ripening in the first trimester missed abortion. Archives of Gynecology and Obstetrics 2005;273(3):144-5. - PubMed
Davis 2004 {published data only}
    1. Davis AR, Robilotto CM, Westhoff CL, Forman S, Zhang J, NICHD MofEPFT. Bleeding patterns after vaginal misoprostol for treatment of early pregnancy failure. Human Reproduction 2004;19(7):1655-8. - PubMed
Dee 2009 {published data only}
    1. Dee MT, Dancel MA. A prospective randomized study comparing the use of intrauterine to vaginal misoprostol for pre-curettage cervical priming of early pregnancy failure. Philippine Journal of Obstetrics & Gynecology 2009;33(3):83.
Dehbashi 2016 {published data only}
    1. Dehbashi Z, Moosazadeh M, Afshari M. Comparison between sublingual and vaginal route of misoprostol in management of first trimester miscarriage missing. Materia Socio-Medica 2016;28(4):271-3. - PMC - PubMed
Devall 2019 {published data only}
    1. Devall A, ISRCTN15586426. A pilot trial to evaluate the benefit of using ultrasound during surgical management of miscarriage. http://www.isrctn.com/ISRCTN15586426 2019.
Dhillon 2015 {published data only}
    1. Dhillon AP, Shergill HK, Yadav P. Comparative study between vaginal isosorbide mononitrate and misoprostol for induction of cervical ripening prior to surgical evacuation of first trimester embryonic demise. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2015;4(2):398-401.
Dickinson 1998 {published data only}
    1. Dickinson JE, Godfrey M, Evans SF. Efficacy of intravaginal misoprostol in second-trimester pregnancy termination: a randomized controlled trial. Journal of Maternal-Fetal Medicine 1998;7:115-9. - PubMed
Dickinson 2002 {published data only}
    1. Dickinson JE, Evans SF. The optimization of intravaginal misoprostol dosing schedules in second-trimester pregnancy termination. American Journal of Obstetrics and Gynecology 2002;186(3):470-4. - PubMed
Dickinson 2003 {published data only}
    1. Dickinson JE, Evans SF. A comparison of oral misoprostol with vaginal misoprostol administration in second-trimester pregnancy termination for fetal abnormality. Obstetrics & Gynecology 2003;101:1294-9. - PubMed
Diop 2009 {published data only}
    1. Diop A, Raghavan S, Rakotovao JP, Comendant R, Blumenthal PD, Winikoff B. Two routes of administration for misoprostol in the treatment of incomplete abortion: a randomized clinical trial. Contraception 2009;79(6):456-62. - PubMed
Dunford 2012 {published data only}
    1. Dunford A, ACTRN12612001254886. Among women with first trimester miscarriage, is the combination of mifepristone plus misoprostol superior to misoprostol alone for reducing the need for surgical uterine evacuation and repeat doses of misoprostol? https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=1261... 2012.
Dunn 2008 {published data only}
    1. Dunn TS, Gregory N, Parrish A, Coddington CC III. Oral misoprostol compared with laminaria before dilation and curettage for missed abortion. Obstetrics & Gynecology 2008;111(4 Suppl):23S.
Egarter 1995 {published data only}
    1. Egarter C, Lederhilger J, Kurz C, Karas H, Reisenberger K. Gemeprost for first trimester missed abortion. Archives of Gynecology & Obstetrics 1995;256(1):29-32. - PubMed
Elami‐Suzin 2013 {published data only}
    1. Elami-Suzin M, Freeman MD, Porat N, Rojansky N, Laufer N, Ben-Meir A. Mifepristone followed by misoprostol or oxytocin for second-trimester abortion: a randomized controlled trial. Obstetrics and Gynecology 2013;122(4):815-20. - PubMed
Elbareg 2018 {published data only}
    1. Elbareg A, Essadi FM. Letrozole combined with misoprostol versus (miso) alone in management of delayed miscarriages. International Journal of Gynecology and Obstetrics 2018;143(S3):387.
Elhassan 2008 {published data only}
    1. Elhassan EM, Abubaker MS, Adam I. Sublingual compared with oral and vaginal misoprostol for termination of pregnancy with second-trimester fetal demise. International Journal of Gynecology & Obstetrics 2008;100(1):82-3. - PubMed
El Sokkary 2016 {published data only}
    1. El Sokkary HHA. Comparison between sublingual and vaginal administration of misoprostol in management of missed abortion. Journal of Obstetrics and Gynaecology of India 2016;66(S1):S24-9. - PMC - PubMed
Eng 1997 {published data only}
    1. Eng NS, Guan AC. Comparative study of intravaginal misoprostol with gemeprost as an abortifacient in second trimester missed abortion. Australian and New Zealand Journal of Obstetrics and Gynaecology 1997;37(3):331-4. - PubMed
Eppel 2005 {published data only}
    1. Eppel W, Facchinetti F, Schleussner E, Piccinini F, Pizzi C, Gruber DM, et al. Second trimester abortion using isosorbide mononitrate in addition to gemeprost compared with gemeprost alone: a double-blind randomized, placebo-controlled multicenter trial. American Journal of Obstetrics and Gynecology 2005;192:856-61. - PubMed
Eslamian 2007 {published data only}
    1. Eslamian L, Gosili R, Jamal A, Alyassin A. A prospective randomized controlled trial of two regimens of vaginal misoprostol in second trimester termination of pregnancy. Acta Medica Iranica 2007;45(6):497-500.
EUCTR2011‐001505‐26‐SE {published data only}
    1. EUCTR2011-001505-26-SE. Repeated doses of misoprostol for medical treatment of intact miscarriage. Http://www.who.int/trialsearch/trial2.aspx? Trialid=euctr2011-001505-26-se 2011.
    1. EUCTR2011-001505-26-SE. Repeated doses of misoprostol for medical treatment of missed abortion. https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_nu... 2011.
Ezzatosadat 2012 {published data only}
    1. Ezzatosadat HJ, IRCT201207259491N3. The effect of adding hyoscine to vaginal misoprostol on shortening the induction time of abortion. http://en.irct.ir/trial/10080 2012.
Facchinetti 2001 {published data only}
    1. Facchinetti F, Piccinini F, Fazzio M, Volpe A. Safety and efficacy of nitroprusside gel for cervical ripening [abstract]. American Journal of Obstetrics and Gynecology 2001;185(6 Suppl):S107.
Fadalla 2004 {published data only}
    1. Fadalla F, Mirghani OA, Adam I. Oral misoprostol vs. vaginal misoprostol for termination of pregnancy with intrauterine fetal demise in the second-trimester. International Journal of Gynecology & Obstetrics 2004;86:52-3. - PubMed
Farooq 2018 {published data only}
    1. Farooq F, Javed L, Mumtaz A, Naveed N. Comparison of manual vacuum aspiration, and dilatation and curettage in the treatment of early pregnancy failure. Journal of Ayub Medical College, Abbottabad : JAMC 2011;23(3):28-31. - PubMed
    1. Farooq F. Comparison of manual vacuum aspiration and dilatation and curettage in the treatment of early pregnancy failure. International Journal of Gynecology and Obstetrics 2018;143(S3):363-4. - PubMed
Faxelid 2012 {published data only}
    1. Faxelid E, NCT01743508. Misoprostol treatment of incomplete abortion by midwives and physicians. A randomized control trial in Uganda. https://clinicaltrials.gov/ct2/show/NCT01743508 2012. - PMC - PubMed
Feldman 2003 {published data only}
    1. Feldman DM, Borgida AF, Rodis JF, Leo MV, Campbell WA. A randomized comparison of two regimens of misoprostol for second-trimester pregnancy termination. American Journal of Obstetrics and Gynecology 2003;189:710-3. - PubMed
Fiala 2005 {published data only}
    1. Fiala C, Swahn ML, Stephansson O, Gemzell-Danielsson K. The effect of non-steroidal anti-inflammatory drugs on medical abortion with mifepristone and misoprostol at 13-22 weeks gestation. Human Reproduction 2005;20(11):3072-7. - PubMed
Firouzabadi 2012 {published data only}
    1. Firouzabadi RD, Sekhavat L, Tabatabaii A, Hamadani S. Laminaria tent versus misoprostol for cervical ripening before surgical process in missed abortion. Archives of Gynecology and Obstetrics 2012;285(3):699-703. - PubMed
Freeman 2016 {published data only}
    1. Freeman MD, Porat N, Rojansky N, Elami-Suzin M, Winograd O, Ben-Meir A. Physical symptoms and emotional responses among women undergoing induced abortion protocols during the second trimester. International Journal of Gynaecology and Obstetrics 2016;135(2):154-7. - PubMed
Ghorab 1998 {published data only}
    1. Ghorab MN, El Helw BA. Second-trimester termination of pregnancy by extra-amniotic prostaglandin F2alpha or endocervical misoprostol A comparative study. Acta Obstetricia et Gynecologica Scandinavica 1998;77:429-32. - PubMed
Gilles 2004 {published data only}
    1. Gilles J, Creinin MM, Barnhart KT, Westhoff C, Frederick MM, Zang J. Wet versus dry intravaginal misoprostol application for treatment of early pregnancy failure [abstract]. Fertility and Sterility 2002;78(3 Suppl 1):S64-5.
    1. Gilles JM, Creinin MD, Barnhart K, Westhoff C, Frederick MM, Zhang J. A randomized trial of saline solution-moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure. American Journal of Obstetrics and Gynecology 2004;190:389-94. - PMC - PubMed
Gonzalez 2001 {published data only}
    1. Gonzalez JA, Carlan SJ, Alverson MW. Outpatient second trimester pregnancy termination. Contraception 2001;63(2):89-93. - PubMed
Graziosi 2005 {published data only}
    1. Graziosi G, Bruinse HW, Reuwer PJ, Teteringen O, Mol BJ. Fertility outcome after a randomized trial comparing curettage with misoprostol for treatment of early pregnancy failure. Human Reproduction 2005;20:1749-50. - PubMed
Grimes 2005 {published data only}
    1. Grimes DA, Smith MS, Witham AD. Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: a pilot randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2005;111:148-53. - PubMed
Gronlund 2002 {published data only}
    1. Gronlund A, Gronlund L, Clevin L, Andersen B, Palmgren N, Lidegaard O. Management of missed abortion: comparison of medical treatment with either mifepristone + misoprostol or misoprostol alone with surgical evacuation. A multi-center trial in Copenhagen county, Denmark. Acta Obstetricia et Gynecologica Scandinavica 2002;81:1060-5. - PubMed
Guix 2005 {published data only}
    1. Guix C, Palacio M, Figueras F, Bennasar M, Zamora L, Coll O, et al. Efficacy of two regimens of misoprostol for early second-trimester pregnancy termination. Fetal Diagnosis and Therapy 2005;20(6):544-8. - PubMed
Halimi 2004 {published data only}
    1. Halimi M. Therapeutic termination of second trimester pregnancy: a comparison of extra-amniotic Foley's catheter balloon alone with the combined use of Foley`s catheter balloon and extra-amniotic instillation of prostaglandin f2-alpha. Journal of Postgraduate Medical Institute 2004;18(3):408-18.
Harrington 2004 {published data only}
    1. Harrington K, ISRCTN14476388. Out-patient management of missed miscarriage: a randomised trial of medical vs medical/minimally invasive management using transcervical amnion rupture. http://www.isrctn.com/ISRCTN14476388 2004.
Hassan 2007 {published data only}
    1. Hassan FI, Mostapha MK, Sattar MA, Marouf E, Azim SA. Oral versus rectal route of misoprostol administration: a randomized controlled trial. Middle East Fertility Society Journal 2007;12(1):53-6.
Hausler 1997 {published data only}
    1. Hausler MC, Koroschetz F, Tamussino K, Walcher W. Is a curettage after spontaneous abortion still relevant? [Ist eine currettage nach abortus completus noch zeitgemals?]. Geburtshilfe und Frauenheilkunde 1997;57:396-9.
Heard 2002 {published data only}
    1. Heard MJ, Stewart GM, Buster JE, Carson SA, Miller HJ. Outpatient management of missed abortion with vaginal misoprostol [abstract]. Obstetrics & Gynecology 2002;99(4 Suppl):20S.
Henshaw 1995 {published data only}
    1. Henshaw RC, Hinshaw K, Smith NC, Templeton AA. The medical management of miscarriage. In: Fertility Society of Australia /Australasian Gynaecological Endoscopy Society; 1995 November 19-25; Melbourne, Australia. 1995:FSA75.
Herabutya 1997 {published data only}
    1. Herabutya Y, O-Prasertsawat P. A comparison of intravaginal misoprostol with intracervical prostaglandin E2 gel for the management of dead fetus in utero. Thai Journal of Obstetrics and Gynaecology 1997;9(2):95-8. - PubMed
Herabutya 1997a {published data only}
    1. Herabutya Y, O-Prasertsawat P. Misoprostol in the management of missed abortion. International Journal of Gynecology & Obstetrics 1997;56(3):263-6. - PubMed
Herabutya 2005 {published data only}
    1. Herabutya Y, Chanrachakul B, Punyavachira P. A randomised controlled trial of 6 and 12 hourly administration of vaginal misoprostol for second trimester pregnancy termination. BJOG: an international journal of obstetrics and gynaecology 2005;112(9):1297-301. - PubMed
Herman 2017 {published data only}
    1. Herman HG, Kerner R, Gluck O, Feit H, Keidar R, Bar J, et al. Different routes of misoprostol for cervical priming in first trimester surgical abortions: a randomized blind trial. Archives of Gynecology and Obstetrics 2017;295:943-50. - PubMed
Hernandez‐Valencia 2003 {published data only}
    1. Hernandez-Valencia M. Cervical ripening with prostaglandin E1: how an ambulatory method decreases the hospital stay in abortus with intrauterine fetal demise. Fetal Diagnosis & Therapy 2003;18:54-8. - PubMed
Hidalgo 2010 {published data only}
    1. Hidalgo M, Guerra M, Reyna E, Santos J, Mejia J, Reyna N, et al. [Isosorbide mononitrate or misoprostol for cervical ripening in missed pregnancies during first trimester] [Mononitrato de isosorbide o misoprostol en maduracion cervical en embarazos interrumpidos durante el primer trimestre]. Clinica e Investigacion en Ginecologia y Obstetricia 2010;37(6):218-22.
Hidar 2001 {published data only}
    1. Hidar S, Fekih M, Chaieb A, Bibi M, Mellouli R, Khairi H. Oxytocin and misoprostol administered intravaginally for termination of pregnancy at 13 to 29 weeks of amenorrhoea. A prospective randomized trial [Apport de l'association d'ocytocine au misoprostol administre en intravaginal au cours des interruptions de grossesses entre 13 et 29 semaines d'amenorrhee. Essai clinique prospectif randomise.]. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 2001;30(5):439-43. - PubMed
Hidar 2005 {published data only}
    1. Hidar S, Bouddebous M, Chaieb A, Jerbi M, Bibi M, Khairi H. Randomized controlled trial of vaginal misoprostol versus vaginal misoprostol and isosorbide dinitrate for termination of pregnancy at 13-29 weeks. Archives of Gynecology and Obstetrics 2005;273(3):157-60. - PubMed
Hill 1991 {published data only}
    1. Hill NC, Selinger M, Ferguson J, MacKenzie IZ. Management of intra-uterine fetal death with vaginal administration of gemeprost or prostaglandin E2: a random allocation controlled trial. Journal of Obstetrics and Gynaecology 1991;11:422-6.
Hinshaw 1995 {published data only}
    1. Hinshaw HK. Medical management of miscarriage. In: Grundzinkas JG, editors(s). Problems in Early Pregnancy - Advances in Diagnosis and Management. London: RCOG, 1997.
    1. Hinshaw K, Rispin R, Henshaw R, Smith N, Templeton A. Medical versus surgical uterine evacuation in first trimester miscarriage: a prospective, pragmatic randomised trial. In: 27th British Congress of Obstetrics and Gynaecology; 1995 July 4-7; Dublin, Ireland. 1995:Abstract no: 4.
    1. Hinshaw K, Rispin R, Smith N, Templeton A. Medical vs surgical management in first trimester miscarriage: a prospective, pragmatic random allocation trial. Journal of Obstetrics and Gynaecology 1993;13(5):404-5.
    1. Rispin R, Hinshaw K, Henshaw R, Smith N, Templeton A. New aspects of care in the management of miscarriage. In: Proceedings of Research in Midwifery Conference; 1993 Sept 14; Birmingham, UK. 1993.
Hogg 2000 {published data only}
    1. Hogg B, Owen J. Laminaria versus extraamniotic saline infusion (EASI) for cervical ripening and mid-trimester labor induction [abstract]. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 2):S135. - PubMed
Hombalegowda 2015 {published data only}
    1. Hombalegowda RB, Samapthkumar S, Vana H, Jogi P, Ramaiah R. A randomized controlled trial comparing different doses of intravaginal misoprostol for early pregnancy failure. Contraception 2015;92(4):364-5.
Hooker 2016 {published data only}
    1. Hooker A, Leeuw R, Thurkow A, Brolmann H, Huirne J. Prevention of adhesions post (spontaneous) abortion (PAPA study); a randomized controlled trial evaluating application of hyaluronic acid (HA). Human Reproduction 2016;31:i30-1.
    1. Hooker A, Leeuw de R, Brolmann H, Huirne J. Does application of auto-cross linker hyaluronic acid in women following d&c for miscarriage with at least one d&c in history improve reproductive outcome? Human Reproduction 2017;32:i135.
    1. Hooker A. Prevention of adhesions post (spontaneous) abortion (PPAPA study); a randomised controlled trial evaluating hyaluronic acid. Gynecological Surgery 2015;12(Suppl 1):S461, Abstract no: ES24-0434.
    1. Hooker AB, Leeuw R, de Ven PM, Bakkum EA, Thurkow AL, Vogel NE, et al. Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: Short-term outcomes of a multicenter, prospective randomized controlled trial. Fertility and Sterility 2017;107(5):1223–31. - PubMed
Huchon 2015 {published data only}
    1. Huchon C, Koskas M, Agostini A, Akladios C, Alouini S, Bauville E, et al. Operative hysteroscopy versus vacuum aspiration for incomplete spontaneous abortion (HY-PER): study protocol for a randomized controlled trial. Trials 2015;16(1):363. - PMC - PubMed
Hughes 1996 {published data only}
    1. Hughes J, Ryan M, Hinshaw K, Henshaw R, Rispin R, Templeton A. The costs of treating miscarriage: a comparison of medical and surgical management. British Journal of Obstetrics and Gynaecology 1996;103(12):1217-21. - PubMed
Ibrahim 2019 {published data only}
    1. Ibrahim HN, Mustafa ZM, Rajab HK. Comparison between the effectiveness of combination of letrozole with misoprostol and tamoxifen with misoprostol in medical termination of first trimester missed miscarriage. Indian Journal of Public Health Research and Development (first received 2019);10(8):2322-7. [CENTRAL: CN-01997127] [EMBASE: 2002799712]
Imran 2010 {published data only}
    1. Imran F, Anser A, Danish N, Fatima N. Misoprostol for the purpose of mid-trimester termination of pregnancy: a comparative study with prostaglandin F2 alpha. Journal of Ayub Medical College, Abbottabad: JAMC 2010;22(4):87-91. - PubMed
IRCT2015112421506N3 2016 {published data only}
    1. IRCT2015112421506N3. INH plus misoprostol vs. misoprostol alone for early medical abortion: clinical trial. http://en.irct.ir/trial/18840 2016.
IRCT2016122729062N1 2016 {published data only}
    1. IRCT2016122729062N1. Analyze the effect of the sesamum indicum on the termination of an incomplete abortion. http://en.irct.ir/trial/23446 2016.
Islam 2006 {published data only}
    1. Islam A, Abbasi AN, Sarwar I. Use of Foley's catheter and prostaglandin F-2 alpha in second trimester termination of pregnancy. Journal of Ayub Medical College, Abbottabad 2006;18(3):35-9. - PubMed
Jabir 2009a {published data only}
    1. Jabir M, Smeet R. Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S209. - PubMed
    1. Jabir M, Smeet RI. Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage. Saudi Medical Journal 2009;30(1):82-7. - PubMed
Jain 1994 {published data only}
    1. Jain JK, Mishell DR. A comparison of intravaginal misoprostol with prostaglandin E2 for termination of second-trimester pregnancy. [comment]. New England Journal of Medicine 1994;331:290-3. - PubMed
Jain 1996 {published data only}
    1. Jain JK, Mishell DR. A comparison of misoprostol with and without laminaria tents for induction of second-trimester abortion. American Journal of Obstetrics and Gynecology 1996;175:173-7. - PubMed
Jain 1999 {published data only}
    1. Jain JK, Mishell DR. A comparison of two dosing regimens of intravaginal misoprostol for second-trimester pregnancy termination. Obstetrics & Gynecology 1999;93:571-5. - PubMed
Jamilian 2014 {published data only}
    1. Jamilian M, IRCT201403244686N11. The comparison of the efficacy of oral castor oil with vaginally misoprostol and vaginally misoprostol alone in the treatment of missed abortion. http://en.irct.ir/trial/5024 2014.
Javadi 2015 {published data only}
    1. Javadi E, IRCT2015050119037N8. Comparison the effect of letrozole plus misoprostol with misoprostol alone on induction of first trimester abortion in pregnant women. http://en.irct.ir/trial/17132 2015.
Johnson 1997 {published data only}
    1. Johnson N, Priestnall M, Marsay T, Ballard P, Watters J. A randomised trial evaluating pain and bleeding after a first trimester miscarriage treated surgically or medically. European Journal of Obstetrics & Gynecology and Reproductive Biology 1997;72(2):213-5. - PubMed
Kakinuma 2020 {published data only}
    1. Kakinuma T, Kakinuma K, Sakamoto Y, Kawarai Y, Saito K, Ihara M, et al. Safety and efficacy of manual vacuum suction compared with conventional dilatation and sharp curettage and electric vacuum aspiration in surgical treatment of miscarriage: a randomized controlled trial. BMC Pregnancy and Childbirth 2020;20(1):695. [CENTRAL: CN-02200866] [EMBASE: 2007309665] [PMID: ] - PMC - PubMed
Kamal 2005 {published data only}
    1. Kamal R, Parveeen F, Mazhar SB. Role of misoprostol in vaginal versus double oro-vaginal route for termination of pregnancy in mid trimester pregnancy. Annals of Pakistan Institute of Medical Sciences 2005;1(4):196-200.
Kanhai 1988 {published data only}
    1. Kanhai HH, Keirse MJ. Intravenous administration of sulfprostone for the induction of labour after fetal death: a randomized comparison of two dose schedules. In: 12th FIGO World Congress of Gynecology and Obstetrics; 1988 October 23-28; Brazil. 1988:201-2.
    1. Kanhai HH, Keirse MJ. Intravenous administration of sulprostone for the induction of labour after fetal death: a randomized comparison of two dose schedules. In: Proceedings of 1st European Congress on Prostaglandins in Reproduction; 1988 July 6-9; Vienna, Austria. 1988:45.
Kanhai 1989 {published data only}
    1. Kanhai HH, Keirse MJ. Induction of labour after fetal death: a randomized controlled trial of two prostaglandin regimens. British Journal of Obstetrics and Gynaecology 1989;96:1400-4. - PubMed
Kapp 2007 {published data only}
    1. Kapp N, Todd CS, Yadgarova KT, Alibayeva G, Nazarova D, Loza O, et al. A randomized comparison of misoprostol to intrauterine instillation of hypertonic saline plus a prostaglandin F2alpha analogue for second-trimester induction termination in Uzbekistan. Contraception 2007;76(6):461-6. - PubMed
Kara 1999 {published data only}
    1. Kara M, Ozden S, Eroglu M, Cetin A, Arioglu P. Comparison of misoprostol and dinoproston administration for the induction of labour in second trimester pregnancies in cases of intrauterine fetal loss. Italian Journal of Gynaecology & Obstetrics 1999;11:13-6.
Khanam 2019 {published data only}
    1. Khanam S, Meraj B, Dawood NS, Asif U. An experience of vaginal misoprostol versus sublingual use in cervical ripening before surgical evacuation. PakistanJjournal of Medical and Health Sciences 2019;13(3):769-71.
Khoosideh 2017 {published data only}
    1. Khoosideh M, Yarmohammadi N, Shahriari A, Sheikh M. Sublingual misoprostol plus laminaria for cervical preparation before surgical management of late first trimester missed abortions, a randomized controlled trial. Journal of Maternal-Fetal & Neonatal Medicine 2017;30(3):317-22. - PubMed
Khosravi 2017 {published data only}
    1. Khosravi D, IRCT2017040633255N1. Comparison of the effect between two dose (800 µg/day & 400 µg/6) of vaginal misoprostol in the termination of first-trimester pregnancy: a double-blinded randomized trial. https://en.irct.ir/trial/25706 (25 June 2017).
Klingberg‐Allvin 2015 {published data only}
    1. Klingberg-Allvin M, Cleeve A, Atuhairwe S, Tumwesigye NM, Faxelid E, Byamugisha J, et al. Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial. Lancet 2015;385(9985):2392-8. - PubMed
    1. Klingberg-Alvin M, Cleeve A, Atuhairwe S, Mbona Tumwesigye N, Faxelid E, Byamugisha J, et al. Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial. International Journal of Gynecology and Obstetrics 2015;131(Suppl 5):E86. - PubMed
Kovavisarach 2005 {published data only}
    1. Kovavisarach E, Jamnansiri C. Intravaginal misoprostol 600ug and 800ug for the treatment of early pregnancy failure. International Journal of Gynecology & Obstetrics 2005;90(3):208-12. - PubMed
Kurshid 2010 {published data only}
    1. Kurshid R, Ahmed A, Mir S, Ul Shamas I. To assess the efficacy of two regimens of misoprostol for second trimester pregnancy termination-a randomized comparison. Internet Journal of Gynecology and Obstetrics 2010;14(1):No pagination.
Kushwah 2009 {published data only}
    1. Kushwah B, Singh A. Sublingual versus oral misoprostol for uterine evacuation following early pregnancy failure. International Journal of Gynecology & Obstetrics 2009;106(1):43-5. - PubMed
    1. Kushwah DS, Kushwah B, Salman MT, Verma VK. Acceptability and safety profile of oral and sublingual misoprostol for uterine evacuation following early fetal demise. Indian Journal of Pharmacology 2011;43(3):306-10. - PMC - PubMed
Lei 2015 {published data only}
    1. Lei Y, ChiCTR-IOR-15007664. Comparion of the treatment efficacy for between combination drug mifepristone and misoprostol abortion and B ultrasound-guided curettage. http://www.chictr.org.cn/showproj.aspx?proj=12889 2015.
Lelaidier 1993 {published data only}
    1. Lelaidier C, Baton-Saint-Mleux C, Fernandez H, Bourget P, Frydman R. Mifepristone (RU486) induces embryo expulsion in first trimester non-developing pregnancies: a prospective randomized trial. Human Reproduction 1993;8(3):492-5. - PubMed
Lemmers 2016 {published data only}
    1. Lemmers M, Verschoor MA, Bossuyt PM, Huirne JA, Spinder T, Nieboer TE, et al. Cost- effectiveness of curettage versus expectant management in women with an incomplete evacuation after misoprostol treatment for first trimester miscarriage: a randomized controlled trial and cohort study. Acta Obstetricia Et Gynecologica Scandinavica 2018;97(3):294-300. - PubMed
    1. Lemmers M, Verschoor MA, Oude Rengerink K, Naaktgeboren C, Opmeer BC, Bossuyt PM, et al. Misorest: surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial. Human Reproduction 2016;31(11):2421-7. - PubMed
    1. Lemmers M, Verschoor MA, Overwater K, Bossuyt PM, Hendriks D, Hemelaar M, et al. Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2017;211:78-82. - PubMed
    1. Verschoor MA, Lemmers M, Bossuyt PM, Graziosi GC, Hajenius PJ, Hendriks DJ, et al. Surgical versus expectant management in women with an incomplete evacuation of the uterus after treatment with misoprostol for miscarriage: the MisoREST trial. BMC Pregnancy and Childbirth 2013;13:102. - PMC - PubMed
    1. Verschoor MA, NTR3310. MisoREST: A multicenter randomized controlled trial comparing curettage and expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage. https://www.trialregister.nl/trial/3166 2012. - PubMed
Leung 2004 {published data only}
    1. Leung SW, Pang MW, Chung TK. Retained products of gestation in miscarriage: an evaluation of transvaginal ultrasound criteria for diagnosing an "empty uterus". American Journal of Obstetrics and Gynecology 2004;191:1133-7. - PubMed
Li 2018 {published data only}
    1. Li X, Wu L, Zhou Y, Fan X, Huang J, Wu J, et al. New crosslinked hyaluronan gel for the prevention of intrauterine adhesions after dilation and curettage in patients with delayed miscarriage: a prospective, multicenter, randomized, controlled trial. Journal of Minimally Invasive Gynecology 2018;26(1):94-9. - PubMed
Linn 2015 {published data only}
    1. Linn TW, Nyunt KK, Ku SK. Effectiveness of low doses vaginal misoprostol in intrauterine fetal death. Journal of Obstetrics and Gynaecology Research 2015;41(Suppl S1):60, Abstract no: FC 10.12.
Lippert 1978 {published data only}
    1. Lippert TH, Luthi A. Induction of labour with prostaglandin E2 gel in cases of intrauterine fetal death. Prostaglandins 1978;15:533-42. - PubMed
Louey 2000 {published data only}
    1. Louey K. Misoprostol for the medical management of miscarriage [ongoing trial]. Personal communication 2000.
Lu 2014 {published data only}
    1. Lu PH, Lu J, Zou S. Comparisons of the effects of misoprostol by two different application on the treatment of missed abortion. Chinese Journal of Pharmaceutical Biotechnology 2014;21(2):159-61.
Lughmani 2007 {published data only}
    1. Lughmani ST. A comparison of intravaginal misoprostol with prostaglandin E2 for termination of 1st trimester pregnancy. BJOG: an international journal of obstetrics and gynaecology 2008;115(s1):179.
    1. Lughmani ST. A comparison of intravaginal misoprostol with prostaglandin E2 for termination of 1st trimester pregnancy. Double blind randomized trial [abstract]. In: 31st British International Congress of Obstetrics and Gynaecology; 2007 July 4-6; London, UK. 2007:209.
Mahjabeen, 2009 {published data only}
    1. Mahjabeen, Khawaja NP, Rehman R. Comparison of oral versus vaginal misoprostol for mid-trimester pregnancy termination. Journal of the College of Physicians & Surgeons Pakistan 2009;19(6):359-62. - PubMed
Makenzius 2017 {published data only}
    1. Makenzius M, Oguttu M, Klingberg-Allvin M, Gemzell-Danielsson K, Odero TM, Faxelid E. Post-abortion care with misoprostol - equally effective, safe and accepted when administered by midwives compared to physicians: a randomised controlled equivalence trial in a low-resource setting in Kenya. BMJ Open 2017;7(10):e016157. - PMC - PubMed
    1. Makenzius M, Oguttu MA, Odera T, Klingberg-Allvin M, Gemzell-Danielsson K, Faxelid E. Post-abortion care (PAC) and contraceptive counselling by midwives or physicians: a facility based study in Kisumu, Western Kenya. In: 31st International Confederation of Midwives Triennial Congress. Midwives - Making a Difference in the World; 2017 June 18-22; Toronto, Canada. 2017:Abstract no: F14.01.
Makhlouf 2003 {published data only}
    1. Makhlouf AM, Al-Hussaini TK, Habib DM, Makarem MH. Second-trimester pregnancy termination: comparison of three different methods. Journal of Obstetrics and Gynaecology 2003;23:407-11. - PubMed
Marfou 2012 {published data only}
    1. Marfou J, Shahbazian N, Abdollahi M. Comparison of effect of oxytocin and prostaglandin E1 on cervix prior to curettage in first trimester. Iranian Journal of Obstetrics, Gynecology and Infertility 2012;15(28):9-12.
Martin 1955 {published data only}
    1. Martin RH, Menzies DN. Oestrogen therapy in missed abortion and labour. Journal of Obstetrics and Gynaecology of the British Commonwealth 1955;62:256-8. - PubMed
Marwah 2016 {published data only}
    1. Marwah S, Gupta S, Batra NP, Bhasin V, Sarna V, Kaur N. A comparative study to evaluate the efficacy of vaginal vs oral prostaglandin E1 analogue (misoprostol) in management of first trimester missed abortion. Journal of Clinical and Diagnostic Research 2016;10(5):QC14-8. - PMC - PubMed
Mitwaly 2016 {published data only}
    1. Mitwaly AB, Abbas AM, Abdellah MS. Intra uterine extra-amniotic versus vaginal misoprostol for termination of second trimester miscarriage: a randomized controlled trial. International Journal of Reproductive Biomedicine 2016;14(10):643-8. - PMC - PubMed
Mizrachi 2017 {published data only}
    1. Mizrachi Y, Dekalo A, Gluck O, Miremberg H, Dafna L, Feldstein O, et al. Single versus repeat doses of misoprostol for treatment of early pregnancy loss-a randomized clinical trial. Human Reproduction 2017;32(6):1202-7. - PubMed
    1. Mizrachi Y, NCT02515604. Comparison of single and repeated dose of vaginal misoprostol for the treatment of early pregnancy failure - a randomized clinical trial. https://clinicaltrials.gov/ct2/show/NCT02515604 2015.
Moran 2005 {published data only}
    1. Moran T, Deutsch R. Methotrexate/misoprostol vs. a more standard approach for termination of pregnancies of undetermined location: a randomized, controlled trial. Journal of Reproductive Medicine 2005;50(10):784-92. - PubMed
Mostafa‐Gharebaghi 2010 {published data only}
    1. Mostafa-Gharebaghi P, Mansourfar M, Sadeghi-Bazargani H. Low dose vaginal misoprostol versus prostaglandin E2 suppository for early uterine evacuation: a randomized clinical trial. Pakistan Journal of Biological Sciences 2010;13(19):946-50. - PubMed
Mulayim 2009 {published data only}
    1. Mulayim B, Celik NY, Onalan G, Zeyneloglu HB, Kuscu E. Sublingual misoprostol after surgical management of early termination of pregnancy. Fertility & Sterility 2009;92(2):678-81. - PubMed
Nakintu 2001 {published data only}
    1. Nakintu N. A comparative study of vaginal misoprostol and intravenous oxytocin for induction of labour in women with intra uterine fetal death in Mulago Hospital, Uganda.[see comment]. African Health Sciences 2001;1(2):55-9. - PMC - PubMed
Nasrollahi 2008 {published data only}
    1. Nasrollahi S, Arab M, Zamani M, Ghafeleh-Bashi M. Comparison between intravenous and intramuscular administration of prostaglandin E2 on management of missed abortion. Journal of Research in Health Sciences 2008;8(2):51-4. - PubMed
Nassar 2005 {published data only}
    1. Nassar AH//NCT00141895. A randomized trial of two regimens of misoprostol for second trimester termination for intrauterine fetal death. clinicaltrials.gov/ct2/show/NCT00141895 (first received 1 September 2005).
Nauman 2016 {published data only}
    1. Nauman D, Saif N, Siddique U, Faruqi NJ. Comparison of manual vacuum aspiration with electrical vacuum aspiration in management of first trimester miscarriages. Pakistan Journal of Medical and Health Sciences 2016;10(2):503-6.
NCT00426491 2007 {published data only}
    1. NCT00426491. Misoprostol for non-viable pregnancies. https://clinicaltrials.gov/show/nct00426491 2007.
NCT00670761 2008 {published data only}
    1. NCT00670761. Misoprostol for the treatment of incomplete abortion: comparison of treatment options. https://clinicaltrials.gov/ct2/show/NCT00670761 2008.
NCT00797693 2008 {published data only}
    1. NCT00797693. Misoprostol in termination of first trimester missed abortion. Https://clinicaltrials.gov/show/nct00797693 2008.
NCT02141555 2014 {published data only}
    1. NCT02141555. Comparing buccal and vaginal misoprostol in management of early pregnancy loss. Https://clinicaltrials.gov/show/nct02141555 2014.
NCT02342002 2015 {published data only}
    1. NCT02342002. Mifepristone and misoprostol versus misoprostol alone for missed abortion: a randomized-controlled trial. https://clinicaltrials.gov/ct2/show/NCT02342002 2015.
NCT02580175 2015 {published data only}
    1. NCT02580175. Surgical evacuation of first trimester missed miscarriage with or without use of transabdominal ultrasound. https://clinicaltrials.gov/ct2/show/NCT02580175 2015.
NCT02957305 2016 {published data only}
    1. NCT02957305. Misoprostol 400 µg versus 200 µg for cervical ripening in 1st trimester miscarriage. Https://clinicaltrials.gov/show/nct02957305 2016.
NCT03148314 2017 {published data only}
    1. NCT03148314. Vaginal misoprostol in management of first trimester missed abortion. https://clinicaltrials.gov/show/nct03148314 2017. - PubMed
NCT03148561 2017 {published data only}
    1. Ali MK, NCT03148561. Misoprostol Versus Expectant Management in Women With Incomplete First-trimester Miscarriage After Misoprostol Treatment: A Randomized Clinical Trial. - PubMed
    1. https://clinicaltrials.gov/ct2/show/NCT03148561 2017.
    1. NCT03148561. Management of women with an incomplete evacuation. https://clinicaltrials.gov/show/nct03148561 2017.
NCT03230825 2017 {published data only}
    1. NCT03230825. Oral contraceptive pills versus expectant management for retained pregnancy products after a first trimester miscarriage: a randomized clinical trial. https://clinicaltrials.gov/ct2/show/NCT03230825 2017.
NCT03628625 2018 {published data only}
    1. NCT03628625. Letrozole pretreatment with misoprostol for induction of abortion in first-trimester missed miscarriage. https://clinicaltrials.gov/show/nct03628625 2018.
Ng 2015 {published data only}
    1. Ng BK, Annamalai R, Lim PS, Aqmar Suraya S, Nur Azurah AG, Muhammad Abdul Jamil MY. Outpatient versus inpatient intravaginal misoprostol for the treatment of first trimester incomplete miscarriage: a randomised controlled trial. Archives of Gynecology and Obstetrics 2015;291:105-13. - PubMed
Ngoc 2004 {published data only}
    1. Ngoc NT, Blum J, Westheimer E, Quan TV, Winikoff B. Medical treatment of missed abortion using misoprostol. International Journal of Gynecology & Obstetrics 2004;87:138-42. - PubMed
Nguyen 2005 {published data only}
    1. Nguyen TN, Blum J, Durocher J, Quan TT, Winikoff B. A randomized controlled study comparing 600 versus 1,200 micrograms oral misoprostol for medical management of incomplete abortion. Contraception 2005;72(6):438-42. - PubMed
Niederauer 2018 {published data only}
    1. Niederauer C, Pezzali L, Selbach T, De Paula Gudes Neto E, Maissiat J, Savaris R. Comparing the 200mug vs 400mug of the new vaginal misoprostol tablets for 1st trimester miscarriage. International Journal of Gynecology and Obstetrics 2018;143(S3):363.
Niromanesh 2005 {published data only}
    1. Niromanesh S, Hashemi-Fesharaki M, Mosavi-Jarrahi A. Second trimester abortion using intravaginal misoprostol. International Journal of Gynecology & Obstetrics 2005;89:276-7. - PubMed
Nor 2006 {published data only}
    1. Nor Azlin MI, Abdullah HS, Zainul Rashid MR, Jamil MA. Misoprostol (alone) in second trimester terminations of pregnancy: as effective as Gemeprost? Journal of Obstetrics and Gynaecology 2006;26(6):546-9. - PubMed
Nuthalapaty 2005 {published data only}
    1. Nuthalapaty F, Ramsey P, Biggio J, Owen J. Comparative efficacy of high dose vaginal misoprostol for mid-trimester labor induction [abstract]. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S73.
    1. Nuthalapaty FS, Ramsey PS, Biggio JR, Owen J. High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: a randomized trial. American Journal of Obstetrics and Gynecology 2005;193(3 Pt 2):1065-70. - PMC - PubMed
Nuutila 1997 {published data only}
    1. Nuutila M, Toivonen J, Ylikorkala O, Halmesmaki E. A comparison between two doses of intravaginal misoprostol and gemeprost for induction of second-trimester abortion. Obstetrics & Gynecology 1997;90(6):896-900. - PubMed
Ogden 2004 {published data only}ISRCTN21348449
    1. Ogden J//ISRCTN21348449. A pragmatic randomised control trial of expectant versus surgical management of first trimester spontaneous miscarriage. isrctn.com/ISRCTN21348449 (first received 23 January 2004).
Owen 1999 {published data only}
    1. Owen J, Hauth JC. Vaginal misoprostol vs. concentrated oxytocin plus low-dose prostaglandin E2 for second trimester pregnancy termination. Journal of Maternal-Fetal Medicine 1999;8(2):48-50. - PubMed
Pang 2001 {published data only}
    1. Pang MW, Chung T. Incomplete miscarriage: a randomized controlled trial comparing oral with vaginal misoprostol for medical evacuation. Human Reproduction 2001;16(11):2283-7. - PubMed
    1. Pang SM, Chung TK. A randomized clinical trial comparing oral and vaginal misoprostol for medical evacuation of spontaneous abortion [abstract]. XVI FIGO World Congress of Obstetrics & Gynecology; 2000 Sept 3-8; Washington DC, USA 2000;Book 3:69.
Pansky 2011 {published data only}
    1. Pansky M, Fuchs N, Ben AI, Tovbin Y, Halperin R, Vaknin Z, et al. Intercoat (Oxiplex/AP Gel) for preventing intrauterine adhesions following operative hysteroscopy for suspected retained products of conception - A pilot study. Journal of Minimally Invasive Gynecology 2011;18(6 Suppl 1):S21. - PubMed
Paraskevaides 1992 {published data only}
    1. Paraskevaides E, Prendiville W, Stuart B, Scanaill SN, Walsh D, McGuinness N, et al. Medical evacuation of first trimester (twelve weeks gestation) incomplete abortion and missed abortion. Journal of Gynecologic Surgery 1992;8(3):159-63.
Paritakul 2010 {published data only}
    1. Paritakul P, Phupong V. Comparative study between oral and sublingual 600 microg misoprostol for the treatment of incomplete abortion. Journal of Obstetrics and Gynaecology Research 2010;36(5):978-83. - PubMed
Perry 1999 {published data only}
    1. Perry KG, Rinehart BK, Terrone DA, Martin RW, May WL, Roberts WE. Second-trimester uterine evacuation: a comparison of intra-amniotic (15S)-15-methyl-prostaglandin F2alpha and intravaginal misoprostol. American Journal of Obstetrics and Gynecology 1999;181:1057-61. - PubMed
Petersen 2013 {published data only}
    1. ACTRN12612000150842. The Medical Management of Miscarriage Study: a randomized controlled clinical trial to determine the optimal dose of misoprostol for medical management of miscarriage before 13 weeks. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=1261... 2012.
    1. Petersen SG, Perkins A, Gibbons K, Bertolone J, Devenish-Meares P, Cave D, et al. Can we use a lower intravaginal dose of misoprostol in the medical management of miscarriage? A randomised controlled study. Australian & New Zealand Journal of Obstetrics & Gynaecology 2013;53(1):64-73. - PubMed
Phupong 2004 {published data only}
    1. 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
Piotrowski 1979 {published data only}
    1. Piotrowski J, Basta A, Klimczyk K, Malolepazy A, Dluzniewska M, Splawinski JA. Indomethacin increases abortifacient effect of PGE2 in man. Prostaglandins 1979;17:451-9. - PubMed
Pomeranz 2016 {published data only}
    1. Pomeranz M, NCT02917785. Testing the efficiency of Karman Curette in the treatment of misoprostol failure in women with missed abortion. https://clinicaltrials.gov/ct2/show/NCT02917785 2016.
Pongsatha 2004 {published data only}
    1. Pongsatha S, Tongsong T. Intravaginal misoprostol for pregnancy termination. International Journal of Gynecology & Obstetrics 2004;87:176-7. - PubMed
Prasartsakulchai 2004 {published data only}
    1. Prasartsakulchai C, Tannirandorn Y. A comparison of vaginal misoprostol 800 microg versus 400 microg in early pregnancy failure: a randomized controlled trial. Journal of the Medical Association of Thailand 2004;87 Suppl 3:S18-23. - PubMed
Promwangkwa 2017 {published data only}
    1. Promwangkwa K, Puntitpong B, Chirdchim W, Sananpanichkul P. Efficacy of sublingual misoprostol with or without loading vaginal misoprostol in second trimester termination of pregnancy: a randomized controlled trial. Journal of the Medical Association of Thailand 2017;100(10):1050-5.
Ragusa 1994 {published data only}
    1. Ragusa A, Vignali MJ, Zanetta G, Norchi S, Zanini A. Pre-operative cervical preparation before first trimester missed abortion: a randomized controlled comparison between single or double intracervical administration of pge2 gel. Prostaglandins Leukotrienes & Essential Fatty Acids 1994;50(5):267-9. - PubMed
Rahimi‐Sharbaf 2015 {published data only}
    1. Rahimi-Sharbaf F, Adabi K, Valadan M, Shirazi M, Nekuie S, Ghaffari P, et al. The combination route versus sublingual and vaginal misoprostol for the termination of 13 to 24 week pregnancies: a randomized clinical trial. Taiwanese Journal of Obstetrics & Gynecology 2015;54(6):660-5. - PubMed
Ramsey 2004 {published data only}
    1. Ramsey PS, Savage K, Lincoln T, Owen J. Vaginal misoprostol versus concentrated oxytocin and vaginal PGE2 for second-trimester labor induction. Obstetrics & Gynecology 2004;104(1):138-45. - PubMed
Rita 2006 {published data only}
    1. Rita Gupta S, Kumar S. A randomised comparison of oral and vaginal misoprostol for medical management of first trimester missed abortion. JK Science 2006;8(1):35-8.
Rivero‐Lopez 1998 {published data only}
    1. Rivero-Lopez E, Marquez-Maraver F, Duenas-Diez JL, Cabezas-Sanchez B. Deferred miscarriage: effectiveness of intravaginal misoprostol versus laminaria stems [Aborto diferido: eficacia del misoprostol intravaginal versus la aplicaci=n de tallos de laminaria]. Progresos de Obstetricia y Ginecologia 1998;41:579-81.
Robledo 2007 {published data only}
    1. 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
Roy 2003 {published data only}
    1. Roy G, Ferreira E, Hudon L, Marquette G. The efficacy of oral versus vaginal misoprostol for second-trimester termination of pregnancy: a double-blind, randomized, placebo controlled trial [abstract]. American Journal of Obstetrics and Gynecology 2003;189(6 Suppl 1):S70.
Ruangchainikhom 2006 {published data only}
    1. Ruangchainikhom W, Phongphissanou E, Bhekasuta J, Sarapak S. Effectiveness of 400 or 600 micrograms of vaginal misoprostol for terminations of early pregnancies. Journal of the Medical Association of Thailand 2006;89(7):928-33. - PubMed
Saciloto 2011 {published data only}
    1. Saciloto MP, Konopka CK, Velho MT, Jobim FC, Resener EV, Muradas RR, et al. [Manual vacuum aspiration uterine treatment of incomplete abortion to 12 gestational weeks: an alternative to curettage]. [Portuguese] [Aspiracao manual intrauterina no tratamento do abortamento incompleto ate 12 semanas gestacionais: uma alternativa a curetagem uterina]. Revista Brasileira de Ginecologia e Obstetricia 2011;33(10):292-6. - PubMed
Saeed 2018 {published data only}
    1. Saeed S, Manzoor R, Tazion S, Butt F, Badar N. Misoprostol for 1st trimester miscarriage: efficacy of vaginal versus oral misoprostol. Pakistan Journal of Medical and Health Sciences 2018;12(2):849-52.
Saichua 2009 {published data only}
    1. Saichua C, Phupong V. A randomized controlled trial comparing powdery sublingual misoprostol and sublingual misoprostol tablet for management of embryonic death or anembryonic pregnancy. Archives of Gynecology and Obstetrics 2009;280(3):431-5. - PubMed
Salamalekis 1990 {published data only}
    1. Salamalekis E, Loghis C, Kassanos D, Traka A, Zourlas PA. Comparison of extra-amniotic prostaglandin F2alpha and dinoprostone use for labor induction after second trimester intrauterine fetal death. In: Proceedings of 12th European Congress of Perinatal Medicine; 1990 Sept 11-14; Lyon, France. 1990:228.
Sewzie 2014 {published data only}
    1. Sewzie B, IRCT2014101015905N2. Effect of sublingual, vaginal and oral misoprostol on treatment of missed abortion in the pregnant women in the first trimester; comparative study. http://en.irct.ir/trial/15026 2014.
Shaamash 2019 {published data only}
    1. Shaamash AH, Khlifah EA, Esmail AM, Abdelmonem SG. Home -based extended low-dose oral misoprostol in management of first-trimester pregnancy loss in low-resource communities: a randomized trial. Journal of Obstetrics and Gynaecology of India 2019 Dec;69(6):501-8. [CENTRAL: CN-01959476] [EMBASE: 628356452] [PMID: ] - PMC - PubMed
Shah 2010 {published data only}
    1. Shah N, Azam SI, Khan NH. Sublingual versus vaginal misoprostol in the management of missed miscarriage. JPMA - Journal of the Pakistan Medical Association 2010;60(2):113-6. - PubMed
Sharifzadeh 2015 {published data only}
    1. Sharifzadeh FS, Dezfooli GA, Chagharvand MM, Azad Z. Comparison of the efficacy of glyceryl trinitrate and misoprostol on cervical ripening for curettage in pregnant women at first trimester. [Persian]. Iranian Journal of Obstetrics, Gynecology and Infertility 2015;18(174):6-11.
Shobeira 2007 {published data only}
    1. Shobeira JM, Atashkhoii S. Second trimester pregnancy termination by intravaginal and parenteral form of prostaglandin E2 [abstract]. In: 31st British International Congress of Obstetrics and Gynaecology; 2007 July 4-6; London, UK. 2007:210.
Shochet 2012 {published data only}
    1. Blandine T, Ouattara AZ, Coral A, Hassane C, Clotaire H, Dao B, et al. Oral misoprostol as first-line care for incomplete abortion in Burkina Faso. International Journal of Gynecology and Obstetrics 2012;119:166-9. - PubMed
    1. Fawole O, Diop A, Adeyanju AO, Aremu OT, Winikoff B. Misoprostol as first-line treatment for incomplete abortion at a secondary-level health facility in Nigeria. International Journal of Gynecology and Obstetrics 2012;119:170-3. - PubMed
    1. NCT01539408. Sublingual misoprostol versus standard surgical care for the treatment of incomplete abortion. https://clinicaltrials.gov/ct2/show/NCT01539408 2012. - PMC - PubMed
    1. Shochet T, Diop A, Gaye A, Nayama M, Sall AB, Bukola F, et al. Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries. BMC Pregnancy and Childbirth 2012;12:127. - PMC - PubMed
Shokry 2009 {published data only}
    1. Shokry M, Shahin AY, Fathalla MM, Shaaban OM. Oral misoprostol reduces vaginal bleeding following surgical evacuation for first trimester spontaneous abortion. International Journal of Gynecology & Obstetrics 2009;107(2):117-20. - PubMed
Sonsanoh 2014 {published data only}
    1. Sonsanoh A, Chullapram T. Comparison of sublingual and vaginal misoprostol for termination of early pregnancy failure: a randomized controlled trial. Thai Journal of Obstetrics and Gynaecology 2014;22(3):128-36.
Souizi 2020 {published data only}
    1. Souizi B, Akrami R, Borzoee F, Sahebkar M. Comparison of the efficacy of sublingual, oral, and vaginal administration of misoprostol in the medical treatment of missed abortion during first trimester of pregnancy: a randomized clinical trial study. Journal of Research in Medical Sciences (first received 2020 Jul 27);25:72. [CENTRAL: CN-02199219] [PMID: ] - PMC - PubMed
Srikhao 2005 {published data only}
    1. Srikhao N, Tannirandorn Y. A comparison of vaginal misoprostol 800 microg versus 400 microg for anembryonic pregnancy: a randomized comparative trial. Journal of the Medical Association of Thailand 2005;88(Suppl 2):S41-S47. - PubMed
Sripramote 2000 {published data only}
    1. Sripramote M, Chatsuphang W. A randomized comparison of oral and vaginal misoprostol for cervical priming before uterine curettage in the first trimester of pregnancy. Vajira Medical Journal 2000;44(3):207-15.
Su 2005 {published data only}
    1. Su L-L, Biswas A, Choolani M, Kalaichelvan V, Singh K. A prospective, randomized comparison of vaginal misoprostol versus intra-amniotic prostaglandins for midtrimester termination of pregnancy. American Journal of Obstetrics and Gynecology 2005;193:1410-4. - PubMed
Suchonwanit 1999 {published data only}
    1. Suchonwanit P. Comparative study between vaginal misoprostol 200 mg and 400 mg in first trimester intrauterine fetal death and anembryonic gestation. Thai Journal of Obstetrics and Gynaecology 1999;11(4):263.
Surita 1997 {published data only}
    1. Surita FG. Misoprostol versus laminaria for cervical ripening in intrauterine fetal death. Acta Obstetricia et Gynecologica Scandinavica Supplement 1997;76(167:2):32.
Sweed 2015 {published data only}
    1. Sweed MS, NCT02401425. Use of letrozole pretreatment with misoprostol for first-trimester medical abortion: randomised controlled trial. https://clinicaltrials.gov/ct2/show/NCT02401425 2015.
Sweed 2018 {published data only}
    1. Sweed MS, NCT03487354. Medical abortion with multiple vs single daily dose of misoprostol in first trimester miscarriage: a randomized clinical trial. https://clinicaltrials.gov/ct2/show/NCT03487354 2018.
Tam 2002 {published data only}
    1. Tam WH, Lau WC, Cheung LP, Yuen PM, Chung TK. Intrauterine adhesions after conservative and surgical management of spontaneous abortion. Journal of the American Association of Gynecologic Laparoscopists 2002;9(2):182-5. - PubMed
Tam 2005 {published data only}
    1. Tam WH, Tsui MH, Lok IH, Yip SK, Yuen PM, Chung TK. Long-term reproductive outcome subsequent to medical versus surgical treatment for miscarriage. Human Reproduction 2005;20(12):3355-9. - PubMed
Tan 1969 {published data only}
    1. Tan PM, Ratnam SS, Quek SP. Vacuum aspiration in the treatment of incomplete abortion. Journal of Obstetrics & Gynaecology of the British Commonwealth 1969;76(9):834-6. - PubMed
Tang 2003 {published data only}
    1. Tang OS, Lau WN, Ng EH, Lee SW, Ho PC. A prospective randomized study to compare the use of repeated doses of vaginal with sublingual misoprostol in the management of first trimester silent miscarriage. Human Reproduction 2003;18(1):176-81. - PubMed
Tang 2006 {published data only}
    1. Tang OS, Ong CY, Tse KY, Ng EH, Lee SW, Ho PC. A randomized trial to compare the use of sublingual misoprostol with or without an additional 1 week course for the management of first trimester silent miscarriage. Human Reproduction 2006;21(1):189-92. - PubMed
Tanha 2010 {published data only}
    1. Tanha FD. Comparison of the efficacy of two routes of misoprostol administration (sublingual and vaginal) for termination of second trimester pregnancy. en.search.irct.ir/view/1614 (first received 28 November 2010).
Tanha 2010a {published data only}
    1. Tanha FD, Feizi M, Shariat M. Sublingual versus vaginal misoprostol for the management of missed abortion. Journal of Obstetrics and Gynaecology Research 2010;36(3):525-32. - PubMed
Tanha 2013 {published data only}
    1. Tanha FD, Golgachi T, Niroomand N, Ghajarzadeh M, Nasr R. Sublingual versus vaginal misoprostol for second trimester termination: A randomized clinical trial. Archives of Gynecology and Obstetrics 2013;287(1):65-9. - PubMed
Tasnim 2011 {published data only}
    1. Tasnim N, Mahmud G, Fatima S, Sultana M. Manual vacuum aspiration: a safe and cost-effective substitute of Electric vacuum aspiration for the surgical management of early pregnancy loss. Journal of the Pakistan Medical Association 2011;61(2):149-53. - PubMed
Tasnim 2014 {published data only}
    1. Tasnim N, Fatima S, Mahmud G. Manual vacuum aspirator: a safe and effective tool for decentralization of post miscarriage care. JCPSP, Journal of the College of Physicians & Surgeons - Pakistan 2014;24(11):815-9. - PubMed
Teymouri 2017 {published data only}
    1. Teymouri B, IRCT2017070934981N1. Comparison of induction of abortion in the first trimester using misoprostol and misoprostol with estrogen priming. http://en.irct.ir/trial/26580 2017.
Thavarasah 1986 {published data only}
    1. Thavarasah AS, Almohdzar SA. Prostaglandin (F2 alpha) in missed abortion Intravenous, extra-amniotic and intramuscular administration--a randomized study. Biological Research in Pregnancy and Perinatology 1986;7:106-10. - PubMed
Thida 2015 {published data only}
    1. Thida M, Shwe MM, Htun KT, Maung NM, Khine EP, Win KS, et al. A randomised clinical trial comparing different routes of administration of repeated doses of 400ug misoprostol for management of missed miscarriages and anembryonic gestations in North Okkalapa General Hospital, Yangon, Myanmar. BJOG: an international journal of obstetrics and gynaecology 2015;122(Suppl S1):26-7.
Thong 2005 {published data only}
    1. Mahmood TA, Shehata KI, Thong KJ. A randomized study of conservative management versus surgical uterine evacuation for incomplete miscarriage (Interim analysis) [abstract]. XVI FIGO World Congress of Obstetrics & Gynecology; 2000 Sept 3-8; Washington DC, USA 2000;Book 3:68-9.
    1. Shehata KI, Thing KJ, Mahmood TA. Interim results of a random allocation study of conservative management versus uterine evacuation for incomplete miscarriage [abstract]. Journal of Obstetrics and Gynaecology 2000;20(1):105-6.
    1. Thong KJ, Mahmood TA, Shehata KI. A randomised trial comparing conservative management versus surgical uterine evacuation for first trimester miscarriage with retained products of conception. NHS Scotland (www.show.scot.nhs.uk/cso/Publications/ExecSumms/Oct_Nov02.htm) (accessed 3 March 2005) 2005.
Toppozada 1994 {published data only}
    1. Toppozada MK, Shaala SA, Anwar MY, Haiba NA, Abdrabbo S, El-Absy HM. Termination of pregnancy with fetal death in the second and third trimesters - the double balloon versus extra-amniotic prostaglandin. International Journal of Gynecology & Obstetrics 1994;45:269-73. - PubMed
Toptas 2011 {published data only}
    1. Toptas T, Mendilcioglu I, Simsek M, Taskin O. Comparison of intravaginal misoprostol alone to combination of intravaginal misoprostol and extraamniotic Foley catheter for the second trimester of pregnancies. American Journal of Obstetrics and Gynecology 2011;204(1 Suppl):S126.
Torky 2018 {published data only}
    1. Torky H, PACTR201701001973403. Misoprostol versus letrozole with misoprostol in the management of first trimester missed miscarriage. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1973 2017.
    1. Torky HA, Marie H, ElDesouky E, Gebreel S, Raslan O, Moussa AA, et al. Letrozole vs. placebo pretreatment in the medical management of first trimester missed miscarriage: a randomized controlled trial. Geburtshilfe Und Frauenheilkunde 2018;78(1):63-9. - PMC - PubMed
Vafaei 2019 {published data only}
    1. Vafaei H, IRCT20140317017034N7. Comparison between herbal medicine myrrh and expectant management for treatment of incomplete abortion. http://en.irct.ir/trial/39363 2019.
Van Mensel 2009 {published data only}
    1. Van Mensel K, Claerhout F, Debois P, Keirse MJ, Hanssens M. A randomized controlled trial of misoprostol and sulprostone to end pregnancy after fetal death [Article ID 496320]. Obstetrics and Gynecology International 2009. - PMC - PubMed
Wieringa‐de 2002 {published data only}
    1. Wieringa-De Waard M, Ankum W. The management of miscarriage: conservative management or curettage? [Het beleid bij een miskraam: afwachten of curettage?]. Tijdschrift voor Fertiliteitsonderzoek 2004;18(1):8-11.
    1. Wieringa-de Waard M, Vos J, Bonsel GJ, Bindels PJ, Ankum WM. Management of miscarriage: a randomized controlled trial of expectant management versus surgical evacuation. Human Reproduction 2002;17(9):2445-50. - PubMed
Wijesinghe 2012 {published data only}
    1. Wijesinghe PS, Herath RP, Abeysundara ID. A qualitative study on patients' perceptions of expectant management of first trimester incomplete miscarriage. Ceylon Medical Journal 2012;57(4):145-9. - PubMed
Yapar 1996 {published data only}
    1. Yapar EG, Senoz S, Urkutur M, Batioglu S, Gokmen O. Second trimester pregnancy termination including fetal death: comparison of five different methods. European Journal of Obstetrics & Gynecology and Reproductive Biology 1996;69:97-102. - PubMed
Yilmaz 2005 {published data only}
    1. Yilmaz B, Kelekci S, Ertas IE, Kahyaoglu S, Ozel M, Sut N, et al. Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial. Human Reproduction 2005;20(11):3067-71. - PubMed
Yilmaz 2007 {published data only}
    1. Yilmaz B, Kelekci S, Ertas IE, Ozel M, Sut N, Mollamahmutoglu L, et al. Randomized comparison of second trimester pregnancy termination utilizing saline moistened or dry misoprostol. Archives of Gynecology and Obstetrics 2007;276(5):511-6. - PubMed
Zanganeh 2010 {published data only}
    1. Zanganeh M// IRCT138902053797N1. Comparing the effects of multiple doses of misoprostol with single dose of misoprostol plus oxytocin in induction of second trimester abortion. en.search.irct.ir/view/2936 (first received 12 June 2010).
Zhang 2000 {published data only}
    1. Zhang C, Cheng W. A contrastive analysis of the efficacy of misoprostol and li fan nuo in intermediate term of pregnancy. Journal of Wuhan University of Science and Technology (Natural Science Edition) 2000;23(4):409-11.

References to studies awaiting assessment

Fang 2009 {published data only}
    1. Fang AH, Chen QF, Zheng W, Li Y, Chen RY. Termination of missed abortion in a combined procedure: a randomized controlled trial. Journal of Reproduction and Contraception 2009;20(1):45-9.

References to ongoing studies

ChiCTR1900023198 2019 {published data only}
    1. ChiCTR1900023198. The incidence of intrauterine adhesion after ultrasound-guided manual vacuum aspiration (USG-MVA): a prospective randomized controlled trial. http://www.chictr.org.cn/showproj.aspx?proj=39134 2019.
ChiCTR‐TRC‐08000725 2008 {published data only}
    1. ChiCTR-TRC-08000725. The physical and psychological outcomes of expectant management, surgical evacuation or medical evacuation with single dose 800 mcg vaginal misoprostol for women with first trimester miscarriage in a randomized controlled trial. http://www.chictr.org.cn/showproj.aspx?proj=8810 2008.
Economides 2004 {published data only}
    1. Economides D, ISRCTN95867389. Non-surgical management of delayed miscarriage: a randomised trial. http://www.isrctn.com/ISRCTN95867389 2004.
Ethayarooban 2017 {published data only}
    1. Ethayarooban E, SLCTR/2017/023. Safety and effectiveness of vacuum aspiration, compared to curettage for management of patients with first trimester miscarriage in a limited resource setting in Sri Lanka. https://slctr.lk/trials/slctr-2017-023 2017.
EUCTR2007‐007661‐20‐SE {published data only}
    1. EUCTR2007-007661-20-SE. Which is the optimal treatment for miscarriage with a gestational sac in the uterus and which factors can predict if the treatment will be successful? https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_nu... 2008.
ISRCTN11046192 2020 {published data only}
    1. ISRCTN11046192. Efficacy of mifepristone followed by misoprostol compared to misoprostol alone in first-trimester miscarriage treatment [The role of Mifepristone on First-trimester miscarriage Treatment (MiFirsT) – a double-blind randomized controlled trial]. Http://www.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN11046192 (first received 2020). [CENTRAL: CN-02188308]
Kopalakrishnan 2014 {published data only}
    1. Kopalakrishnan M, SLCTR/2014/029. Surgical, medical or expectant management of first trimester miscarriage and its implications on clinical and psychological outcomes - a randomized controlled trial. https://slctr.lk/trials/slctr-2014-029 2014.
Otieno 2018 {published data only}
    1. Otieno V, PACTR201810731753052. Outcomes of medical versus surgical management of first trimester incomplete abortion on among women admitted at Kampala International University Teaching Hospital (KIU -TH). https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4665 2018.
PACTR202009610896579 2020 {published data only}
    1. PACTR202009610896579. Misoprostol versus manual vacuum aspiration for the treatment of first trimester incomplete miscarriage at university of Maiduguri teaching hospital. a randomized controlled study. Http://www.who.int/trialsearch/Trial2.aspx?TrialID=PACTR202009610896579 (first received 2020). [CENTRAL: CN-02189183]
PACTR202009857889210 2020 {published data only}
    1. PACTR202009857889210. Sublingual misoprostol versus manual vacuum aspiration for treatment of incomplete abortion in Nigeria: a randomized control study [Misoprostol for incomplete miscarriage]. Http://www.who.int/trialsearch/Trial2.aspx?TrialID=PACTR202009857889210 (first received 2020). [CENTRAL: CN-02189210] [PMID: ] - PMC - PubMed
Sutharshan 2017 {published data only}
    1. Sutharshan R, SLCTR/2017/014. Effectiveness of manual vacuum aspiration when compared to expectant care in achieving complete miscarriage in women with first trimester pregnancy loss - a randomized controlled trial. https://slctr.lk/trials/slctr-2017-014 2017.
Unkels 2008 {published data only}ISRCTN65305620
    1. Unkels R//ISRCTN65305620. Is misoprostol a safe alternative to manual vacuum aspiration in women with early pregnancy failure in a low resource setting? A randomized controlled trial. isrctn.com/ISRCTN65305620 (first received 22 February 2008).

Additional references

Alberman 1992
    1. Alberman E. Spontaneous abortions: epidemiology. In: Stabile I, Grudzinskas JG, Chard T, editors(s). Spontaneous Abortion: Diagnosis and Treatment. London: Springer-Verlag, 1992:9-20.
Al Wattar 2019
    1. Al Wattar BH, Murugesu N, Tobias A, Zamora J, Khan KS. Management of first-trimester miscarriage: a systematic review and network meta-analysis. Human Reproduction Update 2019;25(3):362-74. - PubMed
Brignardello‐Petersen 2018
    1. Brignardello-Petersen R, Bonner A, Alexander PE, Siemieniuk RA, Furukawa TA, Rochwerg B, et al, GRADE Working Group. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. Journal of Clinical Epidemiology 01/01/2018;93:36-44. [https://doi.org/10.1016/j.jclinepi.2017.10.005] - PubMed
Caldwell 2005
    1. Caldwell DM, Ades AE, Higgins JP. Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ 2005;331(7521):897-900. - PMC - PubMed
Caldwell 2010
    1. Caldwell DM, Welton NJ, Ades AE. Mixed treatment comparison analysis provides internally coherent treatment effect estimates based on overviews of reviews and can reveal inconsistency. Journal of Clinical Epidemiology 2010;63(8):875-82. - PubMed
Conway 2000
    1. Conway K, Russell G. Couples’ grief and experience of support in the aftermath of miscarriage. British Journal of Medical Psychology 2000;73(Pt 4):531-45. - PubMed
Davies 2001
    1. Davies NM, Longstreth J, Jamali F. Misoprostol therapeutics revisited. Pharmacotherapy 2001;21(1):60-73. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clinical Trials 1986;7(3):177-88. - PubMed
Dias 2013
    1. Dias S, Welton NJ, Sutton AJ, Caldwell DM, Lu G, Ades AE. Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials. Medical Decision Making 2013;33(5):641-56. - PMC - PubMed
Geller 2001
    1. Geller PA, Klier CM, Neugebauer R. Anxiety disorders following miscarriage. Journal of Clinical Psychiatry 2001;62(6):432–8. - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 2002;21(11):1539-58. - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Higgins 2012
    1. Higgins JP, Jackson D, Barrett JK, Lu G, Ades AE, White IR. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Research Synthesis Methods 2012;3:98-110. - PMC - PubMed
Kim 2017
    1. Kim C, Barnard S, Neilson JP, Hickey M, Vazquez JC, Dou L. Medical treatments for incomplete miscarriage. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No: CD007223. [DOI: 10.1002/14651858.CD007223.pub4] - DOI - PMC - PubMed
Lemmers 2019
    1. Lemmers M, Verschoor MA, Kim BV, Hickey M, Vazquez JC, Mol BW, Neilson JP. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No: CD002253. [DOI: 10.1002/14651858.CD002253.pub4] - DOI - PMC - PubMed
MBRRACE‐UK 2016
    1. Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ, (Eds) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Surveillance of Maternal Deaths in the UK 2012-14 and Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2016.
Nanda 2012
    1. Nanda K, Lopez LM, Grimes DA, Peloggia A, Nanda G. Expectant care versus surgical treatment for miscarriage. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No: CD003518. [DOI: 10.1002/14651858.CD003518.pub3] - DOI - PMC - PubMed
Neugebauer 1997
    1. Neugebauer R, Kline J, Shrout P, Skodol A, O'Connor P, Geller PA, et al. Major depressive disorder in the 6 months after miscarriage. JAMA 1997;277(5):383-8. - PubMed
NICE 2019
    1. National Institute for Health and Clinical Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. https://www.nice.org.uk/guidance/ng126 April 17, 2019. - PubMed
Puhan 2014
    1. Puhan MA, Schünemann HJ, Murad MH, Li T, Brignardello-Petersen R, Singh JA, et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ 2014;349:g5630. - PubMed
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Salanti 2011
    1. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple treatment meta-analysis: An overview and tutorial. Journal of Clinical Epidemiology 2011;64(2):163-71. - PubMed
Schaff 2005
    1. Schaff EA, DiCenzo R, Fielding SL. Comparison of misoprostol plasma concentrations following buccal and sublingual administration. Contraception 2005;71(1):22-5. - PubMed
Shiers 2003
    1. Shiers C. Abnormalities of early pregnancy. In: Myles' Textbook for Midwives. 14th edition. Churchill Livingstone, 2003.
StataCorp. 2019 [Computer program]
    1. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.. College Station, TX: StataCorp, 2019.
Tuncalp 2010
    1. Tunçalp Ö, Gülmezoglu AM, Souza JP. Surgical procedures for evacuating incomplete miscarriage. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No: CD001993. [DOI: 10.1002/14651858.CD001993.pub2] - DOI - PMC - PubMed
Tunçalp 2012
    1. Tunçalp Ö, Hofmeyr GJ, Gülmezoglu AM. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No: CD000494. [DOI: 10.1002/14651858.CD000494.pub4] - DOI - PMC - PubMed
Turner 2012
    1. Turner RM, Davey J, Clarke MJ, Thompson SG, Higgins JP. Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane Database of Systematic Reviews. International Journal of Epidemiology 2012;41(3):818-27. - PMC - PubMed
Veroniki 2013
    1. Veroniki AA, Vasiliadis HS, Higgins JP, Georgia S. Evaluation of inconsistency in networks of interventions. International Journal of Epidemiology 2013;42(1):332–45. - PMC - PubMed
Vogel 2019
    1. Vogel JP, Dowswell T, Lewin S, Bonet M, Hampson L, Kellie F, et al. Developing and applying a 'living guidelines' approach to WHO recommendations on maternal and perinatal health. BMJ Global Health 2019;4:e001683. - PMC - PubMed
White 2011
    1. White I. Multivariate random-effects meta-regression: Updates to mvmeta. Stata Journal 2011;11(2):255-70.
White 2012
    1. White IR, Barrett JK, Jackson D, Higgins JP. Consistency and inconsistency in network meta-analysis: Model estimation using multivariate meta-regression. Research Synthesis Methods 2012;3(2):111-25. - PMC - PubMed
White 2015
    1. White IR. Network meta-analysis. Stata Journal 2015;15:4.
WHO 2009
    1. World Health Organization 2009. Integrated management for emergency and essential surgical care (IMEESC) toolkit. www.who.int/surgery/publications/imeesc/en/ (accessed 10 March 2017).
WHO 2012
    1. World Health Organization. WHO Generic essential emergency equipment list. https://www.who.int/surgery/publications/s15982e.pdf 2012.
WHO 2012a
    1. World Health Organization. Safe abortion: technical and policy guidance for health systems. https://www.who.int/reproductivehealth/publications/unsafe_abortion/9789.... - PubMed
WHO 2018
    1. World Health Organization. Medical management of abortion. Geneva: WHO, 2018. [IGO Licence: CC BY-NC-SA 3.0 IGO] - PubMed
WHO 2019
    1. World Health Organization. World Health Organization Model List of Essential Medicines, 21st List, 2019. https://www.who.int/publications/i/item/WHOMVPEMPIAU2019.06 23rd July 2019.

References to other published versions of this review

Gallos 2017
    1. Gallos ID, Williams HM, Price MJ, Eapen A, Eyo MM, Tobias A, et al. Methods for managing miscarriage: a network meta‐analysis. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No: CD012602. [DOI: 10.1002/14651858.CD012602] - DOI - PMC - PubMed

Publication types

MeSH terms

Associated data