Is Surgical Evacuation Needed Following Incomplete Miscarriage?
This study by Kim et al. (Cochrane Database Systematic Review, 2017) aimed to evaluate the efficacy, safety, and acceptability of medical, surgical or expectant approaches following incomplete miscarriage.
While the study sought to look at loss up to < 24 weeks, the 5,577 women included in this review experienced miscarriage before 13 weeks’ gestation. There was a slightly lower level of complete miscarriage with misoprostol, but high success when compared to surgical evacuation. While there were fewer surgical evacuations with misoprostol, there were more unplanned procedures as well. Nausea, vomiting, and diarrhea were more common amongst women treated with misoprostol, but there was no difference in satisfaction amongst women who received misoprostol vs. surgery. Five trials compared doses or administration routes, or both, of misoprostol and there was no evidence that supported one method over others. Treatment with misoprostol or expectant care are both alternatives to surgical evacuation. More studies exploring miscarriage after 13 weeks are needed.
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