Cochrane Database of Systematic Reviews Medical treatments for incomplete miscarriage (Review) Kim C, Barnard S, Neilson JP, Hickey M, Vazquez JC, Dou L Kim C, Barnard S, Neilson JP, Hickey M, Vazquez JC, Dou L. Medical treatments for incomplete miscarriage. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No.: CD007223. DOI: 10.1002/14651858.CD007223.pub4. www.cochranelibrary.com Medical treatments for incomplete miscarriage (Review) Copyright © 2017 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. ..................................... 13 Figure2. ..................................... 17 Figure3. ..................................... 18 Figure4. ..................................... 19 Figure5. ..................................... 20 Figure6. ..................................... 21 ADDITIONALSUMMARYOFFINDINGS . 36 DISCUSSION ..................................... 40 AUTHORS’CONCLUSIONS . 41 ACKNOWLEDGEMENTS . 42 REFERENCES ..................................... 42 CHARACTERISTICSOFSTUDIES . 55 DATAANDANALYSES. 101 Analysis 1.1. Comparison 1 Misoprostol versus expectant care, Outcome 1 Complete miscarriage. 111 Analysis 1.2. Comparison 1 Misoprostol versus expectant care, Outcome 2 Surgical evacuation. 112 Analysis 1.3. Comparison 1 Misoprostol versus expectant care, Outcome 3 Death or serious complication. 114 Analysis 1.4. Comparison 1 Misoprostol versus expectant care, Outcome 4 Unplanned surgical intervention. 115 Analysis 1.5. Comparison 1 Misoprostol versus expectant care, Outcome 5 Blood transfusion. 116 Analysis 1.6. Comparison 1 Misoprostol versus expectant care, Outcome 6 Pain relief. 117 Analysis 1.7. Comparison 1 Misoprostol versus expectant care, Outcome 7 Pelvic infection < 14 days. 118 Analysis 2.1. Comparison 2 Misoprostol versus surgery, Outcome 1 Complete miscarriage. 119 Analysis 2.2. Comparison 2 Misoprostol versus surgery, Outcome 2 Surgical evacuation. 121 Analysis 2.3. Comparison 2 Misoprostol versus surgery, Outcome 3 Death or serious complication. 123 Analysis 2.4. Comparison 2 Misoprostol versus surgery, Outcome 4 Unplanned surgical intervention. 124 Analysis 2.5. Comparison 2 Misoprostol versus surgery, Outcome 5 Blood transfusion. 126 Analysis 2.6. Comparison 2 Misoprostol versus surgery, Outcome 6 Blood loss. 127 Analysis 2.7. Comparison 2 Misoprostol versus surgery, Outcome 7 Anaemia. 128 Analysis 2.8. Comparison 2 Misoprostol versus surgery, Outcome 8 Days of bleeding. 129 Analysis 2.9. Comparison 2 Misoprostol versus surgery, Outcome 9 Pain relief. 130 Analysis 2.10. Comparison 2 Misoprostol versus surgery, Outcome 10 Pelvic infection < 14 days. 131 Analysis 2.11. Comparison 2 Misoprostol versus surgery, Outcome 11 Cervical damage. 132 Analysis 2.12. Comparison 2 Misoprostol versus surgery, Outcome 12 Digestive disorders. 134 Analysis 2.13. Comparison 2 Misoprostol versus surgery, Outcome 13 Women’s views/acceptability of method. 135 Analysis 2.14. Comparison 2 Misoprostol versus surgery, Outcome 14 Women’s views/satisfaction - continuous data. 136 Analysis 2.15. Comparison 2 Misoprostol versus surgery, Outcome 15 Nausea. 138 Analysis 2.16. Comparison 2 Misoprostol versus surgery, Outcome 16 Vomiting. 139 Analysis 2.17. Comparison 2 Misoprostol versus surgery, Outcome 17 Diarrhoea. 141 Analysis 3.1. Comparison 3 Vaginal misoprostol versus expectant care, Outcome 1 Complete miscarriage. 142 Analysis 3.2. Comparison 3 Vaginal misoprostol versus expectant care, Outcome 2 Surgical evacuation. 143 Analysis 3.3. Comparison 3 Vaginal misoprostol versus expectant care, Outcome 3 Death or serious complication. 144 Analysis 3.4. Comparison 3 Vaginal misoprostol versus expectant care, Outcome 4 Unplanned surgical intervention. 145 Analysis 3.5. Comparison 3 Vaginal misoprostol versus expectant care, Outcome 5 Blood transfusion. 146 Analysis 3.6. Comparison 3 Vaginal misoprostol versus expectant care, Outcome 6 Pain relief. 147 Medical treatments for incomplete miscarriage (Review) i Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 3.7. Comparison 3 Vaginal misoprostol versus expectant care, Outcome 7 Pelvic infection < 14 days. 148 Analysis 4.1. Comparison 4 Vaginal misoprostol versus surgery, Outcome 1 Complete miscarriage. 149 Analysis 4.2. Comparison 4 Vaginal misoprostol versus surgery, Outcome 2 Surgical evacuation. 150 Analysis 4.3. Comparison 4 Vaginal misoprostol versus surgery, Outcome 3 Death or serious complication. 151 Analysis 4.4. Comparison 4 Vaginal misoprostol versus surgery, Outcome 4 Unplanned surgical intervention. 152 Analysis 4.5. Comparison 4 Vaginal misoprostol versus surgery, Outcome 5 Blood transfusion. 153 Analysis 4.6. Comparison 4 Vaginal misoprostol versus surgery, Outcome 6 Anaemia. 154 Analysis 4.7. Comparison 4 Vaginal misoprostol versus surgery, Outcome 7 Days of bleeding. 155 Analysis 4.8. Comparison 4 Vaginal misoprostol versus surgery, Outcome 8 Pain relief. 156 Analysis 4.9. Comparison 4 Vaginal misoprostol versus surgery, Outcome 9 Pelvic infection < 14 days. 157 Analysis 4.10. Comparison 4 Vaginal misoprostol versus surgery, Outcome 10 Women’s views/satisfaction - continuous data...................................... 158 Analysis 4.11. Comparison 4 Vaginal misoprostol versus surgery, Outcome 11 Nausea. 159 Analysis 4.12. Comparison 4 Vaginal misoprostol versus surgery, Outcome 12 Vomiting. 160 Analysis 4.13. Comparison 4 Vaginal misoprostol versus surgery, Outcome 13 Diarrhoea. 161 Analysis 5.1. Comparison 5 Oral misoprostol versus surgery, Outcome 1 Complete miscarriage. 162 Analysis 5.2. Comparison 5 Oral misoprostol versus surgery, Outcome 2 Surgical evacuation. 163 Analysis 5.3. Comparison 5 Oral misoprostol versus surgery, Outcome 3 Unplanned surgical intervention. 164 Analysis 5.4. Comparison 5 Oral misoprostol versus surgery, Outcome 4 Blood transfusion. 165 Analysis 5.5. Comparison 5 Oral misoprostol versus surgery, Outcome 5 Pain relief. 166 Analysis 5.6. Comparison 5 Oral misoprostol versus surgery, Outcome 6 Pelvic infection. 167 Analysis 5.7. Comparison 5 Oral misoprostol versus surgery, Outcome 7 Cervical damage. 168 Analysis 5.8. Comparison 5 Oral misoprostol versus surgery, Outcome 8 Women’s views/acceptability of method. 169 Analysis 5.9. Comparison 5 Oral misoprostol versus surgery, Outcome 9 Nausea. 170 Analysis 5.10. Comparison 5 Oral misoprostol versus surgery, Outcome 10 Vomiting. 171 Analysis 5.11. Comparison 5 Oral misoprostol versus surgery, Outcome 11 Diarrhoea. 172 Analysis 6.1. Comparison 6 Vaginal + oral misoprostol versus surgery, Outcome 1 Complete miscarriage. 173 Analysis 6.2. Comparison 6 Vaginal + oral misoprostol versus surgery, Outcome 2 Surgical evacuation. 174 Analysis 6.3. Comparison 6 Vaginal + oral misoprostol versus surgery, Outcome 3 Days of bleeding. 175 Analysis 6.4. Comparison 6 Vaginal + oral misoprostol versus surgery, Outcome 4 Pelvic infection. 176 Analysis 7.1. Comparison 7 Sublingual misoprostol versus surgery, Outcome 1 Complete miscarriage. 177 Analysis 7.2. Comparison 7 Sublingual misoprostol versus surgery, Outcome 2 Surgical evacuation. 178 Analysis 7.3. Comparison 7 Sublingual misoprostol versus surgery, Outcome 3 Unplanned surgical intervention. 179 Analysis 7.4. Comparison 7 Sublingual misoprostol versus surgery, Outcome 4 Anaemia. 180 Analysis 7.5. Comparison 7 Sublingual misoprostol versus surgery, Outcome 5 Digestive disorders. 181 Analysis 7.6. Comparison 7 Sublingual misoprostol versus surgery, Outcome 6 Women’s views/acceptability of method. 182 Analysis 7.7. Comparison 7 Sublingual misoprostol versus surgery, Outcome 7 Nausea. 183 Analysis 7.8. Comparison 7 Sublingual misoprostol versus surgery, Outcome 8 Vomiting. 184 Analysis 8.1. Comparison 8 Vaginal misoprostol versus oral misoprostol, Outcome 1 Complete miscarriage. 185 Analysis 8.2. Comparison 8 Vaginal misoprostol versus oral misoprostol, Outcome 2 Surgical evacuation. 186 Analysis 8.3. Comparison 8 Vaginal misoprostol versus oral misoprostol, Outcome 3 Unplanned surgical intervention. 187 Analysis 8.4. Comparison 8 Vaginal misoprostol versus oral misoprostol, Outcome 4 Pain relief. 188 Analysis 8.5. Comparison 8 Vaginal misoprostol versus oral misoprostol, Outcome 5 Nausea. 189 Analysis 8.6. Comparison 8 Vaginal misoprostol versus oral misoprostol, Outcome 6 Vomiting. 190 Analysis 8.7. Comparison 8 Vaginal misoprostol versus oral misoprostol, Outcome 7 Diarrhoea. 191 Analysis 9.1. Comparison 9 Oral misoprostol: 600 ug versus 1200 ug, Outcome 1 Complete miscarriage. 192 Analysis 9.2. Comparison 9 Oral misoprostol: 600 ug versus 1200 ug, Outcome 2 Surgical evacuation. 193 Analysis 9.3. Comparison 9 Oral misoprostol: 600 ug versus 1200 ug, Outcome 3 Death or serious complication. 194 Analysis 9.4. Comparison 9 Oral misoprostol: 600 ug versus 1200 ug, Outcome 4 Unplanned surgical intervention. 195 Analysis 9.5. Comparison 9 Oral misoprostol: 600 ug versus 1200 ug, Outcome 5 Women’s views/acceptability of method..................................... 196 Analysis 9.6. Comparison 9 Oral misoprostol: 600 ug versus 1200 ug, Outcome 6 Nausea. 197 Analysis 9.7. Comparison 9 Oral misoprostol: