Expectant, Medical, or Surgical Management of First-Trimester Miscarriage: A Meta-Analysis

Abstract

One additional success can be achieved among 3 women treated surgically rather than medically. Expectant management has had remarkably variable success rates across these studies, depending probably on the type of miscarriage. Greater standardization of outcomes should be a goal of future research.

A randomized study comparing efficacy and patient satisfaction in medical or surgical treatment of miscarriage

“…Our results are consistent with a recent meta-analysis (12), which indicates that surgical management is more likely to induce complete evacuation of the uterus than medical management, although we did not reach statistically significant difference in our study.…”

A Cost-Effectiveness Analysis of Surgical Versus Medical Management of Early Pregnancy Loss

“…The failure rates for the three miscarriage types in the study were 19% for anembryonic gestation, 12% for embryonic or fetal demise and 7% for incomplete or inevitable abortion. Pooled data of medical versus surgical treatment of incomplete miscarriage shows that surgical management had 1.5 times the chance of success over medical management (10). However, the regimens as well as efficacy of medical management for treating incomplete abortion in these studies varied greatly, from 13% success with a single dose of 400μg of misoprostol orally (11) to 95% success with 200μg of misoprostol four times daily (orally) after 200μg of misoprostol intravaginally for 5 days (12).…”

Sublingual misoprostol after surgical management of early termination of pregnancy

“…In a meta-analysis that reviewed expectant, medical, and surgical management of first trimester miscarriages, complete evacuation of the uterus was significantly more common with surgical than with medical management (risk difference, 32.8%; number needed to treat, 3; success rate of medical management, 62%), and moderate or severe bleeding was less common with medical than with expectant management (risk difference, 3.2%) and possibly surgical management (risk difference, 2.1%) (7).…”

“…Different doses of misoprostol for ETP have been reported (3). Medical (especially misoprostol) and surgical management of ETP have been compared in several trials, and differences between the methods regarding complete evacuation and other complications have been reported (4)(5)(6)(7). Bleeding patterns after the medical management of ETP have been assessed and later compared with bleeding patterns of surgical management of ETP (6,8).…”