Medical treatments for incomplete miscarriage in first trimester of pregnancy

Medical treatment with misoprostol is effective for incomplete miscarriage in first trimester of pregnancy, however unplanned surgical curettage occurs more often than after surgical management.

A Cochrane review included 24 studies with a total of 5577 women were included, there were no studies on women over 13 weeks' gestation subjects. 12There was a slightly lower incidence of complete miscarriage with misoprostol (average RR 0.97, 95% CI 0.95 to 0.99; 11 studies, n=2493, random-effects), but with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.06, 95% CI 0.02 to 0.13; 11 studies, n=2654, random-effects) but more unplanned procedures (average RR 5.82, 95% CI 2.93 to 11.56; 9 studies, n=2274). There were few data on ‘deaths or serious complications’. Nausea was more common with misoprostol (average RR 2.41, 95% CI 1.44 to 4.03; 9 studies, n=2179). Five trials compared different routes of administration and/or doses of misoprostol; there was no clear evidence of one regimen being superior to another. 3 trials compared vaginal misoprostol with expectant care. There was no significant difference in complete miscarriage, or in the need for surgical evacuation."?>Three trials involving 335 women compared misoprostol treatment (all vaginally administered) with expectant care. There was no difference in complete miscarriage (average risk ratio (RR) 1.23, 95% confidence interval (CI) 0.72 to 2.10; 2 studies, 150 women, random-effects; very low-quality evidence), or in the need for surgical evacuation (average RR 0.62, 95% CI 0.17 to 2.26; 2 studies, 308 women, random-effects; low-quality evidence). There were few data on 'deaths or serious complications'. For unplanned surgical intervention, we did not identify any difference between misoprostol and expectant care (average RR 0.62, 95% CI 0.17 to 2.26; 2 studies, 308 women, random-effects; low-quality evidence).

Sixteen trials involving 4044 women addressed the comparison of misoprostol (7 studies used oral administration, 6 studies used vaginal, 2 studies sublingual, 1 study combined vaginal + oral) with surgical evacuation. There was a slightly lower incidence of complete miscarriage with misoprostol (average RR 0.96, 95% CI 0.94 to 0.98; 15 studies, 3862 women, random-effects; very low-quality evidence) but with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol (average RR 0.05, 95% CI 0.02 to 0.11; 13 studies, 3070 women, random-effects; very low-quality evidence) but more unplanned procedures (average RR 5.03, 95% CI 2.71 to 9.35; 11 studies, 2690 women, random-effects; low-quality evidence). There were few data on 'deaths or serious complications'. Nausea was more common with misoprostol (average RR 2.50, 95% CI 1.53 to 4.09; 11 studies, 3015 women, random-effects; low-quality evidence). No difference in women's satisfaction between misoprostol and surgery was identified (average RR 1.00, 95% CI 0.99 to 1.00; 9 studies, 3349 women, random-effects; moderate-quality evidence). More women had vomiting and diarrhoea with misoprostol compared with surgery (vomiting: average RR 1.97, 95% CI 1.36 to 2.85; 10 studies, 2977 women, random-effects; moderate-quality evidence; diarrhoea: average RR 4.82, 95% CI 1.09 to 21.32; 4 studies, 757 women, random-effects; moderate-quality evidence).

Five trials compared different routes of administration, or doses, or both, of misoprostol. There was no clear evidence of one regimen being superior to another.

Ədəbiyyat

1. . Kim C, Barnard S, Neilson JP et al. Medical treatments for incomplete miscarriage. Cochrane Database Syst Rev 2017;(1):CD007223.