Article type
Year
Abstract
Background: Miscarriage is an important cause of morbidity and mortality during the first half of pregnancy, especially in developing countries. Traditionally, surgical curettage was performed to remove any retained products of conception. Various types of medical treatment could be suitable as alternatives to surgical treatment, such as Misoprostol and other drugs, including ergometrine, oxytocin, prostaglandins, mifepristone and methotrexate.
Objectives: To assess the effectiveness and safety of different managements for miscarriage, in terms of death or complications, additional surgical evacuation, blood transfusion, haemorrhage, blood loss, anemia, days of bleeding, pain relief, pelvic infection, cervical damage, digestive disorders, hypertensive disorders, duration of stay in hospital, psychological effects, subsequent fertility, patient satisfaction and costs.
Search strategy: The primary source of studies was the Pregnancy and Childbirth Group's Specialized Register of Controlled Trials. The Cochrane Controlled Trials Register was also searched. Hand-searching were performed and meeting abstracts were searched. Selection criteria: Randomized or quasi-randomized clinical trials comparing medical treatment with another treatment, placebo, or no treatment for miscarriage were considered. Data collection & analysis: We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes (if available) such as miscarriage not complete, death; serious complications (e.g. uterine rupture, uterine perforation, hysterectomy, organ failure, Intensive Care Unit admission), additional surgical evacuation; blood transfusion; haemorrhage; blood loss; anemia; days of bleeding; pain relief; pelvic infection; cervical damage; digestive disorders; hypertensive disorders; duration of stay in hospital; psychological effects; subsequent fertility; patient satisfaction; and costs.
Main results: Surgical evacuation of retained products of conception (ERPC) versus oral misoprostol: More patients required analgesia for pain relief in misoprostol group (Odds Ratio [OR] 5.96, 95% Confidence Interval [CI] 3.53, 10.06). There were no statistically significant differences for the other outcomes measures. There were no statistically significant differences for the outcomes considered when comparing intramuscular methotrexate plus vaginal misoprostol versus vaginal misoprostol alone. Administration of vaginal misoprostol was better than expectant management only for the outcome miscarriage not complete (OR 0.23, 95% CI 0.08, 0.66). Oral and vaginal misoprostol were equally effective for all the considered outcomes, except for diarrhoea which was significantly more frequent in oral misoprostol group compared to vaginal administration of misoprostol (OR 7.55, 95% CI 4.25, 13.42).
Reviewers' conclusions: Misoprostol is an effective and safe alternative for the management of the first-trimester miscarriage. Rates of success (complete abortion) are high and complications are unfrequent, as well as side effects, but the use of misoprostol may be limited by economic reasons. Even if an additional surgical procedure has to be performed, misoprostol has demonstrated to be helpful to open the external os of the cervix, reducing the risk of uterine perforation. Additional research are necessary in order to evaluate the economic implications of the use of misoprostol, some other important outcome measures, the optimal dosage and route of administration, long term outcome such as subsequent fertility and the management of miscarriage after 13 weeks of pregnancy.
Objectives: To assess the effectiveness and safety of different managements for miscarriage, in terms of death or complications, additional surgical evacuation, blood transfusion, haemorrhage, blood loss, anemia, days of bleeding, pain relief, pelvic infection, cervical damage, digestive disorders, hypertensive disorders, duration of stay in hospital, psychological effects, subsequent fertility, patient satisfaction and costs.
Search strategy: The primary source of studies was the Pregnancy and Childbirth Group's Specialized Register of Controlled Trials. The Cochrane Controlled Trials Register was also searched. Hand-searching were performed and meeting abstracts were searched. Selection criteria: Randomized or quasi-randomized clinical trials comparing medical treatment with another treatment, placebo, or no treatment for miscarriage were considered. Data collection & analysis: We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes (if available) such as miscarriage not complete, death; serious complications (e.g. uterine rupture, uterine perforation, hysterectomy, organ failure, Intensive Care Unit admission), additional surgical evacuation; blood transfusion; haemorrhage; blood loss; anemia; days of bleeding; pain relief; pelvic infection; cervical damage; digestive disorders; hypertensive disorders; duration of stay in hospital; psychological effects; subsequent fertility; patient satisfaction; and costs.
Main results: Surgical evacuation of retained products of conception (ERPC) versus oral misoprostol: More patients required analgesia for pain relief in misoprostol group (Odds Ratio [OR] 5.96, 95% Confidence Interval [CI] 3.53, 10.06). There were no statistically significant differences for the other outcomes measures. There were no statistically significant differences for the outcomes considered when comparing intramuscular methotrexate plus vaginal misoprostol versus vaginal misoprostol alone. Administration of vaginal misoprostol was better than expectant management only for the outcome miscarriage not complete (OR 0.23, 95% CI 0.08, 0.66). Oral and vaginal misoprostol were equally effective for all the considered outcomes, except for diarrhoea which was significantly more frequent in oral misoprostol group compared to vaginal administration of misoprostol (OR 7.55, 95% CI 4.25, 13.42).
Reviewers' conclusions: Misoprostol is an effective and safe alternative for the management of the first-trimester miscarriage. Rates of success (complete abortion) are high and complications are unfrequent, as well as side effects, but the use of misoprostol may be limited by economic reasons. Even if an additional surgical procedure has to be performed, misoprostol has demonstrated to be helpful to open the external os of the cervix, reducing the risk of uterine perforation. Additional research are necessary in order to evaluate the economic implications of the use of misoprostol, some other important outcome measures, the optimal dosage and route of administration, long term outcome such as subsequent fertility and the management of miscarriage after 13 weeks of pregnancy.