A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14-28 weeks of gestation.
Abortifacient Agents, Nonsteroidal
/ administration & dosage
Abortifacient Agents, Steroidal
/ administration & dosage
Abortion, Induced
/ adverse effects
Dose-Response Relationship, Drug
Female
Fetal Death
Humans
Mifepristone
/ administration & dosage
Misoprostol
/ administration & dosage
Pregnancy
Pregnancy Trimester, Second
Randomized Controlled Trials as Topic
Intrauterine fetal death
Medical management
Mifepristone
Misoprostol
Second trimester
Systematic review
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
06
02
2019
revised:
28
05
2019
accepted:
05
09
2019
pubmed:
8
9
2019
medline:
22
1
2020
entrez:
8
9
2019
Statut:
ppublish
Résumé
Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established. To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. Research databases from January 2006 to October 2018. Randomized controlled trials with IUFD cases at 14-28 weeks of gestation. We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. Sixteen trials from 1695 citations. When misoprostol is used alone, 400 μg is more effective than 200 μg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low. Misoprostol 400 μg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.
Sections du résumé
BACKGROUND
BACKGROUND
Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established.
OBJECTIVES
OBJECTIVE
To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD.
SEARCH STRATEGY
METHODS
Research databases from January 2006 to October 2018.
SELECTION CRITERIA
METHODS
Randomized controlled trials with IUFD cases at 14-28 weeks of gestation.
DATA COLLECTION AND ANALYSIS
METHODS
We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence.
MAIN RESULTS
RESULTS
Sixteen trials from 1695 citations. When misoprostol is used alone, 400 μg is more effective than 200 μg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low.
CONCLUSIONS
CONCLUSIONS
Misoprostol 400 μg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.
Substances chimiques
Abortifacient Agents, Nonsteroidal
0
Abortifacient Agents, Steroidal
0
Misoprostol
0E43V0BB57
Mifepristone
320T6RNW1F
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
301-312Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Organisme : Department of Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research
Organisme : Development and Research Training in Human Reproduction (HRP)
Informations de copyright
© 2019 World Health Organization; licensed by International Federation of Gynecology and Obstetrics.
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