Isosorbide mononitrate vaginal gel versus misoprostol vaginal gel versus Dilapan-S® for cervical ripening before first trimester curettage

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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“…They found ISMN to be less effective than the other two agents. Mild discomfort was indicated by all patients after Dilapan insertion while mild hypotension and headache occurred in 3 out of 22 women of the ISMN group [10].…”

Section: Misoprostol Plus Isosorbide Mononitrate Versus Misoprostol F...mentioning

confidence: 87%

“…However, both regimes were found to be associated with a high frequency of side effects [9]. Chen et al, 2008, scheduled 65 pregnant women with missed abortion between 6 and 12 gestational weeks who randomly assigned to receive either 80 mg ISMN vaginal gel (group 1) or 200 μg of misoprostol vaginal gel (group 2) or Dilapan-S, a hygroscopical cervical dilator (group 3), for cervical ripening before curettage. They found ISMN to be less effective than the other two agents.…”

Section: Misoprostol Plus Isosorbide Mononitrate Versus Misoprostol F...mentioning

confidence: 99%

Misoprostol plus Isosorbide Mononitrate versus Misoprostol for Termination of Anembryonic Pregnancy

2021

AHS

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Objective: Is to to assess the efficacy and safety of vaginal misoprostol plus isosorbide mononitrate versus misoprostol in termination of anembryonic pregnancy. Setting: Department of Obstetrics and Gynecology, Woman’s Health Hospital, Assiut University. Methods: 108 women scheduled for termination of anembryonic pregnancy were recruited were assigned randomly to vaginal misoprostol 800 g plus isosorbide mononitrate 40 mg or vaginal misoprostol 800 g plus placebo .The efficacy of the medication was evaluated by predetermined outcome variables for Successful expulsion of gestational sac in both groups and need for surgical interference.

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Nitric oxide donors for cervical ripening in first-trimester surgical abortion

Promsonthi

Preechapornprasert

Chanrachakul

2009

Cochrane Database of Systematic Reviews

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Isosorbide mononitrate vaginal gel versus misoprostol vaginal gel versus Dilapan-S® for cervical ripening before first trimester curettage

Cited by 13 publications

References 14 publications

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

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

Misoprostol plus Isosorbide Mononitrate versus Misoprostol for Termination of Anembryonic Pregnancy

Nitric oxide donors for cervical ripening in first-trimester surgical abortion

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