Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Abstract

The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were included in our analysis. Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug, lower-dose regimens (200 ug or 400 ug) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours. In terms of efficacy, the most effective treatment was sublingual misoprostol of 600 ug and the least effective was oral misoprostol of 400 ug. In terms of tolerability, vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects. Misoprostol is a non-invasive, effective medical method for completion of abortion in missed abortion. Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose. The ideal dose and medication interval of misoprostol however needs to be further researched.Missed abortion is defined as unrecognized intrauterine death of the embryo or fetus without expulsion of the products of conception. It constitutes approximately 15% of clinically diagnosed pregnancies 1 . Women experiencing a missed abortion may have no self-awareness due to the lack of obvious symptoms.With around 95% success rate, surgical evacuation is regarded as the standard treatment for missed abortion, which had been widely performed all over the world in the past 50 years 2 . However, the costs of surgery and hospitalization, as well as the complications associated with surgery and anaesthesia are a major unresolved concern. Besides infection and bleeding, decreased fertility caused by intrauterine adhesions may be unacceptable for women with missed abortion, who have not yet fulfilled their motherhood desires. Some studies have thus suggested that expectant or medical management might be more suitable instead of surgical evacuation 3,4 .Expectant management has been reported with unpredictable success rate ranging from 25-76% 5-7 . Waiting for spontaneous expulsion of the products of conception would waste much time, during which women may suffer uncertainty and anxiety 5 . When additional surgical evacuation is needed owing to failure, they may suffer from an emotional breakdown. It is thus not recommended for missed early miscarriage due to the risks of emergency surgical treatment and blood transfusion 8 .Misoprostol is a synthetic prostaglandin E1 analogue which was originally developed to prevent non-steroidal anti-inflammatory drugs related gastric ulcers. However it has been used for various other indications in obstetrics and gynaecology. Medical manag...

Pigment epithelium‑derived factor facilitates NLRP3 inflammasome activation through downregulating cytidine monophosphate kinase 2: A potential treatment strategy for missed abortion

“…Missed abortion (MA) refers to the unrecognized intrauterine death of the embryo or fetus without spontaneous expulsion in the first 20 weeks of gestation (1), and it constitutes ~15% of diagnosed cases of stillbirth in the clinical setting (2). Women who suffer from MA may not be aware of a potential issue due to a lack of obvious symptoms.…”

Retrospective analysis of prognostic value of the neutrophil-to-lymphocyte ratio in early miscarriages

“…Besides infection and bleeding, decreased fertility caused by intrauterine adhesions may be unacceptable for women with missed abortion who have not yet fulfilled their motherhood desires. [ 5 ] Thus, we evaluated whether the NLR value significantly differed between the patients with threatened and missed abortions and whether NLR is useful for determining the prognostic factor of early miscarriage.…”

Effect of misoprostol with and without letrozole on the induction of abortion for women with first‐trimester missed abortion

“…Because these methods are expensive and involve anesthesia, however, medical methods are generally preferred over surgical methods for abortion 3 . Medical approaches include prostaglandins, both alone and in combination with other drugs 3–6 . Among various prostaglandins, prostaglandin E1 (misoprostol) has received marked attention because of its high safety and the possibility of outpatient use 7 .…”