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Medical Treatment for Early Fetal Death (Less Than 24 Weeks) (Review) Cochrane Database of Systematic Reviews Medical treatment for early fetal death (less than 24 weeks) (Review) Lemmers M, Verschoor MAC, Kim BV, Hickey M, Vazquez JC, Mol BWJ, Neilson JP Lemmers M, Verschoor MAC, Kim BV, Hickey M, Vazquez JC, Mol BWJ, Neilson JP. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD002253. DOI: 10.1002/14651858.CD002253.pub4. www.cochranelibrary.com Medical treatment for early fetal death (less than 24 weeks) (Review) Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 6 OBJECTIVES ..................................... 7 METHODS ...................................... 7 RESULTS....................................... 11 Figure1. ..................................... 12 Figure2. ..................................... 14 Figure3. ..................................... 15 ADDITIONALSUMMARYOFFINDINGS . 24 DISCUSSION ..................................... 27 AUTHORS’CONCLUSIONS . 29 ACKNOWLEDGEMENTS . 29 REFERENCES ..................................... 30 CHARACTERISTICSOFSTUDIES . 43 DATAANDANALYSES. 116 Analysis 1.1. Comparison 1 Vaginal misoprostol versus placebo, Outcome 1 Complete miscarriage. 125 Analysis 1.2. Comparison 1 Vaginal misoprostol versus placebo, Outcome 2 Death or serious complications: uterine perforation. .................................. 126 Analysis 1.3. Comparison 1 Vaginal misoprostol versus placebo, Outcome 3 Blood transfusion. 126 Analysis 1.4. Comparison 1 Vaginal misoprostol versus placebo, Outcome 4 Blood loss: haemoglobin difference > 10 g/L. ..................................... 127 Analysis 1.5. Comparison 1 Vaginal misoprostol versus placebo, Outcome 5 Days of bleeding: vaginal bleeding 2 weeks aftertreatment. ... ... ... ... ... ... ... ... ... ... .. 127 Analysis 1.6. Comparison 1 Vaginal misoprostol versus placebo, Outcome 6 Nausea. 128 Analysis 1.7. Comparison 1 Vaginal misoprostol versus placebo, Outcome 7 Diarrhoea. 128 Analysis 1.8. Comparison 1 Vaginal misoprostol versus placebo, Outcome 8 Pain (opiate use). 129 Analysis 1.9. Comparison 1 Vaginal misoprostol versus placebo, Outcome 9 Woman’s satisfaction with treatment. 129 Analysis 2.1. Comparison 2 Vaginal misoprostol versus expectant management, Outcome 1 Complete miscarriage. 130 Analysis 2.2. Comparison 2 Vaginal misoprostol versus expectant management, Outcome 2 Pelvic infection. 130 Analysis 3.1. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 1 Complete miscarriage. 131 Analysis 3.2. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 2 Uterine perforation. 132 Analysis 3.3. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 3 Blood loss: post-treatment haematocrit(%).................................. 132 Analysis 3.4. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 4 Pain relief. 133 Analysis 3.5. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 5 Pelvic infection. 133 Analysis 3.6. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 6 Nausea. 134 Analysis 3.7. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 7 Diarrhoea. 134 Analysis 3.8. Comparison 3 Vaginal misoprostol versus surgical evacuation of uterus, Outcome 8 Woman’s satisfaction. 135 Analysis 4.1. Comparison 4 Vaginal misoprostol versus vaginal dinoprostone, Outcome 1 Complete miscarriage. 135 Analysis 4.2. Comparison 4 Vaginal misoprostol versus vaginal dinoprostone, Outcome 2 Blood transfusion. 136 Analysis 4.3. Comparison 4 Vaginal misoprostol versus vaginal dinoprostone, Outcome 3 Nausea. 136 Analysis 4.4. Comparison 4 Vaginal misoprostol versus vaginal dinoprostone, Outcome 4 Duration of hospital stay (days). .................................... 137 Analysis 5.1. Comparison 5 Vaginal misoprostol lower versus higher-dose regimens, Outcome 1 Complete miscarriage < 13 weeks. .................................... 137 Analysis 5.2. Comparison 5 Vaginal misoprostol lower versus higher-dose regimens, Outcome 2 Complete miscarriage 13- 23weeks. ................................... 138 Analysis 5.3. Comparison 5 Vaginal misoprostol lower versus higher-dose regimens, Outcome 3 Nausea. 139 Medical treatment for early fetal death (less than 24 weeks) (Review) i Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 5.4. Comparison 5 Vaginal misoprostol lower versus higher-dose regimens, Outcome 4 Diarrhoea. 139 Analysis 6.1. Comparison 6 Vaginal misoprostol wet versus dry vaginal preparations, Outcome 1 Complete miscarriage. 140 Analysis 6.2. Comparison 6 Vaginal misoprostol wet versus dry vaginal preparations, Outcome 2 Diarrhoea. 141 Analysis 6.3. Comparison 6 Vaginal misoprostol wet versus dry vaginal preparations, Outcome 3 Vomiting. 141 Analysis 6.4. Comparison 6 Vaginal misoprostol wet versus dry vaginal preparations, Outcome 4 Acceptability of method: would wish/probably wish same treatment in future nonviable pregnancy. 142 Analysis 7.1. Comparison 7 Vaginal misoprostol + methotrexate versus vaginal misoprostol alone, Outcome 1 Complete miscarriage. .................................. 142 Analysis 7.2. Comparison 7 Vaginal misoprostol + methotrexate versus vaginal misoprostol alone, Outcome 2 Haemorrhage................................... 143 Analysis 7.3. Comparison 7 Vaginal misoprostol + methotrexate versus vaginal misoprostol alone, Outcome 3 Pain relief. 143 Analysis 8.1. Comparison 8 Vaginal misoprostol plus laminaria tents versus vaginal misoprostol alone, Outcome 1 Complete miscarriage. .................................. 144 Analysis 9.1. Comparison 9 Vaginal misoprostol versus sublingual misoprostol, Outcome 1 Complete miscarriage < 13 weeks. .................................... 145 Analysis 9.2. Comparison 9 Vaginal misoprostol versus sublingual misoprostol, Outcome 2 Complete miscarriage 13-23 weeks. .................................... 146 Analysis 9.3. Comparison 9 Vaginal misoprostol versus sublingual misoprostol, Outcome 3 Blood loss: excessive (> menstruation). ................................. 146 Analysis 9.4. Comparison 9 Vaginal misoprostol versus sublingual misoprostol, Outcome 4 Pain. 147 Analysis 9.5. Comparison 9 Vaginal misoprostol versus sublingual misoprostol, Outcome 5 Nausea. 148 Analysis 9.6. Comparison 9 Vaginal misoprostol versus sublingual misoprostol, Outcome 6 Vomiting. 149 Analysis 9.7. Comparison 9 Vaginal misoprostol versus sublingual misoprostol, Outcome 7 Diarrhoea. 149 Analysis 10.1. Comparison 10 Vaginal misoprostol versus intravenous oxytocin, Outcome 1 Complete miscarriage 13-23 weeks. .................................... 150 Analysis 10.2. Comparison 10 Vaginal misoprostol versus intravenous oxytocin, Outcome 2 Blood loss: excessive. 151 Analysis 11.1. Comparison 11 Vaginal misoprostol versus vaginal gemeprost, Outcome 1 Complete miscarriage 13-23 weeks. .................................... 151 Analysis 11.2. Comparison 11 Vaginal misoprostol versus vaginal gemeprost, Outcome 2 Opiates for pain relief. 152 Analysis 11.3. Comparison 11 Vaginal misoprostol versus vaginal gemeprost, Outcome 3 Vomiting. 152 Analysis 11.4. Comparison 11 Vaginal misoprostol versus vaginal gemeprost, Outcome 4 Diarrhoea. 153 Analysis 12.1. Comparison 12 Sublingual misoprostol versus oral misoprostol, Outcome 1 Complete miscarriage. 153 Analysis 12.2. Comparison 12 Sublingual misoprostol versus oral misoprostol, Outcome 2 Pain. 154 Analysis 12.3. Comparison 12 Sublingual misoprostol versus oral misoprostol, Outcome 3 Nausea and/or vomiting. 155 Analysis 12.4. Comparison 12 Sublingual misoprostol versus oral misoprostol, Outcome 4 Diarrhoea. 156 Analysis 12.5. Comparison 12 Sublingual misoprostol versus oral misoprostol, Outcome 5 Woman’s satisfaction with treatment.................................... 157 Analysis 13.1. Comparison 13 Sublingual powdery versus sublingual compact misoprostol, Outcome 1 Complete miscarriage. .................................. 157 Analysis 13.2. Comparison 13 Sublingual powdery versus sublingual compact misoprostol, Outcome 2 Nausea/vomiting. 158 Analysis 13.3. Comparison 13 Sublingual powdery versus sublingual compact misoprostol, Outcome 3 Diarrhoea. 158 Analysis 14.1. Comparison 14 Sublingual misoprostol with versus without extended course, Outcome 1 Complete miscarriage. .................................. 159 Analysis 14.2. Comparison 14 Sublingual misoprostol with versus without extended course, Outcome 2 Nausea. 160 Analysis 14.3. Comparison 14 Sublingual misoprostol with versus without extended course, Outcome 3 Pain. 160 Analysis 14.4. Comparison 14 Sublingual misoprostol with versus without extended course, Outcome 4 Vomiting. 161 Analysis 14.5. Comparison 14 Sublingual misoprostol with versus without extended course, Outcome 5 Diarrhoea. 161 Analysis 15.1. Comparison 15 Sublingual + vaginal misoprostol versus only vaginal misoprostol, Outcome 1 Complete miscarriage. .................................. 162 Analysis 15.2. Comparison 15 Sublingual + vaginal misoprostol versus only vaginal misoprostol, Outcome 2 Blood loss: haemoglobinlevel. 162 Analysis 15.3. Comparison 15 Sublingual + vaginal misoprostol
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