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Medical treatments for incomplete miscarriage
James P Neilson1, Gillian M L Gyte, Martha Hickey
1Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK. jneilson@liverpool.ac.uk.
The Cochrane Database of Systematic Reviews
|April 2, 2013
Summary
Medical treatment with misoprostol and expectant care are viable alternatives to surgical evacuation for early miscarriage. Women should be offered informed choices based on available health services and personal preferences.
Area of Science:
- Reproductive Medicine
- Obstetrics and Gynecology
- Clinical Trials
Background:
- Miscarriage affects 10-15% of pregnancies, with surgical evacuation being the traditional treatment.
- Alternative options like medical management or expectant care are being explored for effectiveness, safety, and acceptability.
Purpose of the Study:
- To evaluate the effectiveness, safety, and acceptability of medical treatments for incomplete miscarriage before 24 weeks gestation.
Main Methods:
- Systematic review of randomized controlled trials comparing medical treatment with expectant care or surgical evacuation.
- Searched Cochrane Pregnancy and Childbirth Group's Trials Register and reference lists.
- Two independent reviewers assessed study inclusion, risk of bias, and data extraction.
Main Results:
- Twenty studies (4208 women) were included; no trials specifically addressed miscarriage after 13 weeks.
- Misoprostol treatment showed no significant difference in complete miscarriage rates compared to expectant care.
- Compared to surgical evacuation, misoprostol resulted in fewer surgical procedures but more unplanned interventions and nausea.
Conclusions:
- Medical treatment (misoprostol) and expectant care are acceptable alternatives to surgical evacuation for early miscarriage.
- Informed choice should be offered to women experiencing miscarriage before 13 weeks.
- Future research should incorporate long-term follow-up to assess subsequent fertility.
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