Misoprostol for uterine evacuation during miscarriage: A systematic review

Abstract

Miscarriage is an important cause of morbidity and mortality especially in developing countries. Traditionally, miscarriage is treated by surgical curettage. Misoprostol has been introduced in recent years for treatment of miscarriage. In this review, we systematically searched for and combined the evidence from randomized controlled trials comparing misoprostol with surgical curettage. The objective of this study was to evaluate the effectiveness and safety of misoprostol compared with surgical curettage for the management of miscarriage. The HINARI (Health InterNetwork Access to Research Initiative), the MEDLINE and the Cochrane Controlled Trials Register were systematically searched up to June 15, 2004. The reference lists of the retrieved articles were also searched. Trial quality was assessed and data extracted for analysis which was performed using RevMan software. Four studies were included in the review. Patients on misoprostol were 19 times more likely to have incomplete uterine evacaution than those who underwent curettage (OR 19.38, 95% CI 11.34 to 33.12). Misoprostol was associated with a significantly higher incidence of nausea, diarrhoea and need for pain relief, but reduced the risk of uterine perforation and severe bleeding. In conclusion misoprostol is less effective than surgical curettage in terms of complete

Mother and Child Health Clinics Vol. 1(3) 2004: 188-193