Cochrane for Clinicians

Putting Evidence into Practice

Misoprostol for Incomplete First Trimester Miscarriage



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Am Fam Physician. 2014 Apr 1;89(7):523-524.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See CME Quiz Questions.

Author disclosure: No relevant financial affiliations.

Clinical Question

How does management with misoprostol (Cytotec) compare with expectant management or uterine aspiration in women with incomplete first trimester miscarriage?

Evidence-Based Answer

Misoprostol, administered by various routes, is as effective as expectant management and nearly as effective as uterine aspiration. All three options have high success rates for completing miscarriage. Women treated with misoprostol had higher rates of nausea, prolonged bleeding, and unplanned surgery, but roughly 95% (1,280 out of 1,355) were able to avoid having an invasive surgical procedure. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Miscarriage occurs in up to 15% of pregnancies, and it commonly presents as bleeding during the first trimester.1 Threatened miscarriage refers to vaginal bleeding with a closed cervical os. About one-half of affected women eventually miscarry, although the risk is much lower if a fetal heartbeat has been detected.2 The term inevitable miscarriage refers to the leakage of amniotic fluid with an open cervical os. Miscarriage is incomplete if the placenta and fetus have not been fully expelled. This Cochrane review focuses on women who have symptomatic incomplete miscarriage. A 2006 Cochrane review by the same authors addressed misoprostol use for fetal demise in early pregnancy before the occurrence of miscarriage symptoms (i.e.,


The practice recommendations in this activity are available at http://summaries.cochrane.org/CD007223.

SOURCE

Neilson JP, Gyte GM, Hickey M, Vazquez JC, Dou L. Medical treatments for incomplete miscarriage. Cochrane Database Syst Rev. 2013;(3):CD007223.

REFERENCES

1. Misoprostol for miscarriages. Med Lett Drugs Ther. 2013;55(1411):19–20.

2. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap L, Wenstrom KD. Abortion. In: Williams Obstetrics. 22nd ed. New York, NY: McGraw-Hill; 2005:239–241.

3. Neilson JP, Hickey M, Vazquez J. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database Syst Rev. 2006;(3):CD002253.

4. Doubilet PM, Benson CB, Bourne T, et al.; Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013;369(15):1443–1451.

These are summaries of reviews from the Cochrane Library.

The series coordinator for AFP is Corey D. Fogleman, MD, Lancaster General Hospital Family Medicine Residency, Lancaster, Pa.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.



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