A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss

Background There is a substantial body of research evaluating ways to prevent and manage miscarriage, but all studies do not report on the same outcomes. Objective To review systematically, outcomes reported in existing miscarriage trials. Search strategy MEDLINE, Embase, CINAHL, and Cochrane were searched from inception until January 2017. Selection criteria Randomised controlled trials (RCTs) reporting prevention or management of miscarriage. Miscarriage was defined as a pregnancy loss in the first trimester. Data collection and analysis Data about the study characteristics, primary, and secondary outcomes were extracted. Main results We retrieved 1553 titles and abstracts, from which 208 RCTs were included. For prevention of miscarriage, the most commonly reported primary outcome was live birth and the top four reported outcomes were pregnancy loss/stillbirth (n = 112), gestation of birth (n = 68), birth dimensions (n = 65), and live birth (n = 49). For these four outcomes, 58 specific measures were used for evaluation. For management of miscarriage, the most commonly reported primary outcome was efficacy of treatment. The top four reported outcomes were bleeding (n = 186), efficacy of miscarriage treatment (n = 105), infection (n = 97), and quality of life (n = 90). For these outcomes, 130 specific measures were used for evaluation. Conclusions Our review found considerable variation in the reporting of primary and secondary outcomes along with the measures used to assess them. There is a need for standardised patient‐centred clinical outcomes through the development of a core outcome set; the work from this systematic review will form the foundation of the core outcome set for miscarriage. Tweetable abstract There is disparity in the reporting of outcomes and the measures used to assess them in miscarriage trials.

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“…A total of 114 RCTs were included in the review . The PRISMA flow chart in Figure S1 shows study selection.…”

Section: Resultsmentioning

confidence: 99%

Outcomes in prevention and management of miscarriage trials: a systematic review

Smith

Dhillon-Smith

O’Toole

et al. 2018

BJOG

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“…The costs are lower for expectant management. A subsequent randomised controlled trial (360 participants), however, reported no statistically significant difference in complete uterine evacuation at 6 weeks 13…”

Section: What Is the Evidence Of Uncertainty?mentioning

confidence: 95%

What is the best method for managing early miscarriage?

Chu

Hardy

Beeson

et al. 2020

BMJ

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Methods for managing miscarriage: a network meta-analysis

Ghosh

Papadopoulou

Devall

et al. 2021

Cochrane Database of Systematic Reviews

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A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss

Cited by 5 publications

References 25 publications

Outcomes in prevention and management of miscarriage trials: a systematic review

Outcomes in prevention and management of miscarriage trials: a systematic review

What is the best method for managing early miscarriage?

Methods for managing miscarriage: a network meta-analysis

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