Misoprostol versus manual vacuum aspiration for treatment of  first-trimester incomplete miscarriage in a low-resource setting: A randomized controlled trial

Nwafor, Johnbosco Ifunanya; Agwu, UM; Egbuji, Chuma C; Ekwedigwe, Kenneth Chinedu

doi:10.4103/njcp.njcp_379_19

Cited by 12 publications

(4 citation statements)

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“…Eight studies involving 1,950 patients who underwent treatment with either misoprostol or MVA were included for meta-analysis. 20 21 22 23 24 25 26 27 …”

Section: Resultsmentioning

confidence: 99%

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis

Silva,

Araujo,

Simões

et al. 2023

Rev Bras Ginecol Obstet

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Objective To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. Data sources The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Selection of studies Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data collection Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. Data synthesis When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07–0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96–4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52–0.80). No statistically significant differences were observed in the general acceptability of the treatments. Conclusion Misoprostol has been determined as a safe option with good acceptance by patients.

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“…Eight studies involving 1,950 patients who underwent treatment with either misoprostol or MVA were included for meta-analysis. 20 21 22 23 24 25 26 27 …”

Section: Resultsmentioning

confidence: 99%

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis

Silva,

Araujo,

Simões

et al. 2023

Rev Bras Ginecol Obstet

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“…This low percentage is most likely due to routine antibiotic use among all women. [ 1 7 ] Compared to women who had manual vacuum aspiration, those who received misoprostol reported significantly less pain but more blood. [ 1 ] Women were largely pleased with their care, regardless of the method used.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing the Management of Incomplete Abortion with Oral 600 mg Misoprostol with Manual Vacuum Aspiration (MVA)

Madhual,

Tiwari,

Das

et al. 2024

Journal of Pharmacy and Bioallied Sciences

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Introduction: In the first trimester, almost one in five identified pregnancies end in spontaneous miscarriage, and another 22% result in induced abortion. After a spontaneous and/or induced abortion, there may be retained products of conception (POC). Because of its relatively poor efficacy and the unpredictability of the time interval until spontaneous evacuation, expectant treatment is not often chosen by healthcare professionals. In view of these facts, the current study’s objective was to weigh the effectiveness of MVA and oral misoprostol 600 mg in managing incomplete abortion. Materials and Procedures: The investigation was conducted at the tertiary care center in India. The survey was conducted for one year. Subjects were selected from those attending the department for either spontaneous or induced abortions. A total of 230 women were randomly assigned to receive the interventions of a single dose of oral misoprostol 600 mcg or MVA. They were equally distributed to two groups and observed for the various parameters of success, signs and symptoms, satisfaction, and complications. The obtained values were compared statistically for the significance at <0.05 of P values. Results: Of the 200 subjects (30 lost to follow-up), there was no significant variance in the demographics, clinical outcomes, and complications between the groups. However, the pain, fever, shivering, and satisfaction parameters were statistically variant between the groups. Fever, shivering, and pain were lower for the MISO subjects while satisfaction was reported higher from subjects in MISO group. Conclusion: MISO and MVA are acceptable, safe, and efficient therapies for first-trimester un-complicated incomplete abortion. Nonetheless, misoprostol appears to be a marginally superior option to MVA in terms of accessibility, low therapy costs, reduced pain, and reduced demand for specialized personnel or equipment.

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“…Misoprostol is a promising medical treatment option as an alternative of MVA for its satisfactory rate of complete uterine evacuation, and tolerable adverse events. So far, several studies have been launched to appraise the feasibility of misoprostol as an alternative of MVA in conditions where medical equipment like ultrasonography or well-trained surgeons were not available, but the results of these studies varied from one another [13][14][15][16][17][18][19] . Consequently, we carried out this systematic review and meta-analysis to evaluate the relative e cacy, safety concerns and patients' subjective evaluation of misoprostol and MVA.…”

Section: Discussionmentioning

confidence: 99%

“…With a purpose to guide the choice between MVA and misoprostol in rst trimester incomplete abortion, several high-quality prospective randomized controlled trials have been carried out to weigh their e ciency for complete uterine evacuation as well as safety concerns, while inconsistency came up among studies [13][14][15][16][17][18][19] . Particularly, the prevalence of adverse events following MVA or misoprostol use in rst trimester incomplete abortion have varied greatly among different studies.…”

Section: Introductionmentioning

confidence: 99%

Comparison of misoprostol and manual vacuum aspiration in treating first-trimester incomplete miscarriage: a systematic review and meta-analysis of randomized controlled trials

Jin,

Zhang,

Yang

et al. 2023

Preprint

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Background To provide evidence of the comparative curative efficiency and prevalence of treatment-related adverse events following manual vacuum aspiration (MVA) or misoprostol in first trimester incomplete abortion.Methods We comprehensively searched international medical literature databases, including PubMed, Medline, Ovid, Embase, and Web of science for related articles published between 2005 and 2023. After article screening, seven articles were finally included in the meta-analysis after assessment for risk of bias. Important parameters of the included studies were strictly extracted. Stata 17MP was used to compare the proportion of complete uterine evacuation, necessity for additional MVA, prevalence of adverse effects (abdominal pain, bleeding, fever, chills, nausea and vomiting), patients’ subjective evaluation and publication bias. Meta-regression was also performed.Results Seven eligible studies of 1097 patients receiving misoprostol and 1079 patients receiving MVA were included, and MVA was found to have better performance than misoprostol in terms of complete uterine evacuation (RR = 0.972, P༜0.001), regardless of age, gestational age, parity, dosage of misoprostol, and marital status. Meanwhile, misoprostol was related to higher possibility for additional MVA (RR = 7.112, P༜0.001). In terms of adverse events, misoprostol medication led to more frequent bleeding (RR = 1.91, P༜0.001), chills (RR = 7.5, P = 0.018), fever (RR = 4.34, P = 0.001), nausea (RR = 3.13, P = 0.005), and vomiting (2.21, P = 0.008).Conclusion MVA outperformed misoprostol in terms of accomplishing complete uterine evacuation in patients with first-trimester incomplete miscarriage. Moreover, the occurrence rate of adverse events was lower in MVA group than that in misoprostol group. However, since the rate of complete uterine evacuation after MVA and misoprostol were both over 90%, misoprostol was also considered as an alternative for MVA in limited resources settings.Trial registration: The research was formally registered on International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202350113) before statistical analysis.

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Misoprostol versus manual vacuum aspiration for treatment of first-trimester incomplete miscarriage in a low-resource setting: A randomized controlled trial

Cited by 12 publications

References 0 publications

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis

A Randomized Controlled Trial Comparing the Management of Incomplete Abortion with Oral 600 mg Misoprostol with Manual Vacuum Aspiration (MVA)

Comparison of misoprostol and manual vacuum aspiration in treating first-trimester incomplete miscarriage: a systematic review and meta-analysis of randomized controlled trials

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