Management of early pregnancy loss.
OBJECTIVE
In order to assess the available evidence on the management of early pregnancy loss, we performed a meta-analysis on the subject.


METHODS
MEDLINE and EMBASE were searched for randomized studies reporting on the effectiveness of expectant management, misoprostol treatment or curettage. Outcomes considered were 'complete evacuation', complications, duration of bleeding, pain resulting from the procedure, side effects and women's satisfaction with the procedure.


RESULTS
Thirteen studies were identified. Combined data in women with missed abortion managed expectantly or treated with misoprostol showed complete evacuation rates of 28% (49/173) (range 14-47%) and 81% (242/298) (range 60-83%), respectively. In women with incomplete abortion, these rates were 94% (31/33) (range 80-100%) and 99% (75/76) (range 99-100%), respectively.


CONCLUSIONS
In the management of early pregnancy loss both expectant management and misoprostol treatment reduce the need for curettage, but misoprostol treatment seems to be more effective in women with missed abortion as compared to expectant management.
Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands. p.graziosi@antonius.net
G C M
GC
Graziosi
B W
BW
Mol
W M
WM
Ankum
H W
HW
Bruinse
D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000022:Abortion, Spontaneous / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003475:Curettage; D005260:Female; D006801:Humans; D016239:MEDLINE; D016595:Misoprostol / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol