Methods for managing miscarriage: a network meta‐analysis

Jay Ghosh; Argyro Papadopoulou; Adam J Devall; Hannah C Jeffery; Leanne E Beeson; Vivian Do; Malcolm J Price; Aurelio Tobias; Özge Tunçalp; Antonella Lavelanet; Ahmet Metin Gülmezoglu; Arri Coomarasamy; Ioannis D Gallos

doi:10.1002/14651858.CD012602.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Topics

Temas

Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 4

Network diagram for outcome of complete miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 5

Cumulative rankogram comparing each of the methods of management of a miscarriage for incomplete miscarriage subgroup analysis for the outcome of complete miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 6

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of complete miscarriage.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 7

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of complete miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 8

Network diagram for outcome of composite outcome of death or serious complication. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 9

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of composite outcome of death or serious complication.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 10

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of composite outcome of death or serious complication. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 11

Network diagram for outcome of need for unplanned/ emergency surgical procedure. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 12

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of need for unplanned/ emergency surgical procedure.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 13

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of need for unplanned/ emergency surgical procedure. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 14

Network diagram for outcome of pain score (visual analogue scale). The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 15

Network diagram for outcome of pelvic inflammatory disease, sepsis or endometritis. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 16

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of pelvic inflammatory disease, sepsis or endometritis.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 17

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of pelvic inflammatory disease, sepsis or endometritis. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 18

Network diagram for outcome of mean volumes of blood loss (millilitres). The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 19

Network diagram for outcome of change in haemoglobin measurements before and after the miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 20

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of change in haemoglobin measurements before and after the miscarriage.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 21

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of change in haemoglobin measurements before and after the miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 22

Network diagram for outcome of days of bleeding. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 23

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of days of bleeding.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 24

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of days of bleeding. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 25

Network diagram for outcome of mean duration of hospital stay (days). The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 26

Network diagram for outcome of readmission to hospital. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 27

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of readmission to hospital.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 28

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of readmission to hospital. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 29

Network diagram for outcome of nausea. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 30

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of nausea.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 31

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of nausea. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 32

Network diagram for outcome of vomiting. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 33

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of vomiting.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 34

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of vomiting. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 35

Network diagram for outcome of diarrhoea. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 36

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of diarrhoea.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 37

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of diarrhoea. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 38

Network diagram for outcome of pyrexia. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 39

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for outcome of pyrexia.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 40

Cumulative rankogram comparing each of the methods of management of a miscarriage for the outcome of pyrexia. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 41

Network diagram for missed miscarriage subgroup analysis of outcome of complete miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 42

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for missed miscarriage subgroup of complete miscarriage outcome.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 43

Cumulative rankogram comparing each of the methods of management of a miscarriage for missed miscarriage subgroup analysis for the outcome of complete miscarriage. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 44

Network diagram for missed miscarriage subgroup analysis of outcome of days of bleeding. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 45

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for missed miscarriage subgroup of the days of bleeding outcome.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 46

Cumulative rankogram comparing each of the methods of management of a miscarriage for missed miscarriage subgroup analysis for the outcome of days of bleeding. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 47

Network diagram for incomplete miscarriage subgroup analysis of outcome of complete miscarriage. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 48

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for incomplete miscarriage subgroup of complete miscarriage outcome.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 49

Network diagram for incomplete miscarriage subgroup analysis of outcome of days of bleeding. The nodes represent an intervention and their size is proportional to the number of trials comparing this intervention to any other in the network. The lines connecting each pair of interventions represent a direct comparison and are drawn proportional to the number of trials making each direct comparison. Numbers on the lines represent the number of trials and participants for each comparison. The colour of the line is green for high‐certainty evidence; light green for moderate‐certainty evidence; orange for low‐certainty evidence and red for very low‐certainty evidence. Multi‐arm trials contribute to more than one comparison.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 50

Forest plot with relative risk ratios and 95% CIs from pairwise, indirect and network (combining direct and indirect) analyses for incomplete miscarriage subgroup of the days of bleeding outcome.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 51

Cumulative rankogram comparing each of the methods of management of a miscarriage for incomplete miscarriage subgroup analysis for the outcome of days of bleeding. Ranking indicates the cumulative probability of being the best method, the second best, the third best, etc. The x axis shows the relative ranking and the y‐axis the cumulative probability of each ranking. We estimate the SUrface underneath this Cumulative RAnking line (SUCRA); the larger the SUCRA the higher its rank among all available methods.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1: Suction aspiration vs Misoprostol, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1: Suction aspiration vs Misoprostol, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1: Suction aspiration vs Misoprostol, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1: Suction aspiration vs Misoprostol, Outcome 4: Pain score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1: Suction aspiration vs Misoprostol, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1: Suction aspiration vs Misoprostol, Outcome 6: Change in haemoglobin measurements before and after the miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1: Suction aspiration vs Misoprostol, Outcome 7: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1: Suction aspiration vs Misoprostol, Outcome 8: Cervical tear

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1: Suction aspiration vs Misoprostol, Outcome 9: Mean duration of hospital stay (days)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

Comparison 1: Suction aspiration vs Misoprostol, Outcome 10: Re‐admission to hospital

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.11

Comparison 1: Suction aspiration vs Misoprostol, Outcome 11: Nausea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.12

Comparison 1: Suction aspiration vs Misoprostol, Outcome 12: Vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.13

Comparison 1: Suction aspiration vs Misoprostol, Outcome 13: Diarrhoea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.14

Comparison 1: Suction aspiration vs Misoprostol, Outcome 14: Pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.15

Comparison 1: Suction aspiration vs Misoprostol, Outcome 15: Anxiety score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.16

Comparison 1: Suction aspiration vs Misoprostol, Outcome 16: Depression score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2: Suction aspiration vs Mifepristone + Misoprostol, Outcome 5: Re‐admission to hospital

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 5: Mean volumes of blood loss (millilitres)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.6

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 6: Change in haemoglobin measurements before and after the miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.7

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 7: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.8

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 8: Cervical tear

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.9

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 9: Mean duration of hospital stay (days)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.10

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 10: Re‐admission to hospital

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.11

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 11: Vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.12

Comparison 3: Suction aspiration vs Dilatation & Curettage, Outcome 12: Pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.3

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.4

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.5

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 5: Mean volumes of blood loss (millilitres)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.6

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 6: Change in haemoglobin measurements before and after the miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.7

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 7: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.8

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 8: Cervical tear

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.9

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 9: Mean duration of hospital stay (days)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.10

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 10: Re‐admission to hospital

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.11

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 11: Vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.12

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 12: Diarrhoea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.13

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 13: Pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.14

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 14: Anxiety score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.15

Comparison 4: Suction aspiration vs Expectant/ Placebo, Outcome 15: Depression score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.1

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.2

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.3

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.4

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 4: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.5

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 5: Change in haemoglobin measurements before and after the miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.6

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 6: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.7

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 7: Re‐admission to hospital

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.8

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 8: Nausea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.9

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 9: Vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.10

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 10: Diarrhoea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.11

Comparison 5: Misoprostol vs Mifepristone + Misoprostol, Outcome 11: Pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.1

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.2

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.3

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.4

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 4: Pain score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.5

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.6

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 6: Mean volumes of blood loss (millilitres)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.7

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 7: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.8

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 8: Cervical tear

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.9

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 9: Re‐admission to hospital

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.10

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 10: Vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.11

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 11: Nausea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.12

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 12: Diarrhoea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.13

Comparison 6: Misoprostol vs Dilatation & Curettage, Outcome 13: Depression score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 7.1

Comparison 7: Misoprostol vs Suction aspiration + Cervical preparation, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 7.2

Comparison 7: Misoprostol vs Suction aspiration + Cervical preparation, Outcome 2: Pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.1

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.2

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.3

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.4

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 4: Pain score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.5

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.6

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 6: Change in haemoglobin measurements before and after the miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.7

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 7: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.8

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 8: Mean duration of hospital stay (days)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.9

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 9: Re‐admission to hospital

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.10

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 10: Nausea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.11

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 11: Vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.12

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 12: Diarrhoea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.13

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 13: Pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.14

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 14: Anxiety score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.15

Comparison 8: Misoprostol vs Expectant/ Placebo, Outcome 15: Depression score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.1

Comparison 9: Dilatation & Curettage vs Expectant/ Placebo, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.2

Comparison 9: Dilatation & Curettage vs Expectant/ Placebo, Outcome 2: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.3

Comparison 9: Dilatation & Curettage vs Expectant/ Placebo, Outcome 3: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.1

Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 1: Complete Miscarriage

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.2

Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 2: Composite outcome of death or serious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.3

Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 3: Need for unplanned/emergency surgical procedure

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.4

Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 4: Pain score

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.5

Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 5: Pelvic inflammatory disease, sepsis or endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.6

Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 6: Days of bleeding

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.7

Comparison 10: Mifepristone + Misoprostol vs Expectant/ Placebo, Outcome 7: Pyrexia

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings 1. Complete miscarriage

Medical and surgical management compared with expectant management or placebo for treating missed early miscarriage
Patient or population: women with missed miscarriage at ≤14 weeks gestation Settings: hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: complete miscarriage
Intervention	Network evidence		Direct evidence		Indirect evidence		*Illustrative comparative risks (95% CI) for NMA estimate**
Intervention	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Risk with standard care	Risk with intervention	Risk difference with intervention
Suction aspiration plus cervical preparation	2.12 (1.41 to 3.20)	⊕⊕⊖⊖ LOW^a	Not reported by included studies	‐	2.12 (1.41 to 3.20)	⊕⊕⊖⊖ LOW^b	640 per 1000	1000 per 1000	360 more per 1,000 (from 182 more to 577 more)
Suction aspiration	1.44 (1.29 to 1.62)	⊕⊕⊖⊖ LOW^c	1.27 (1.08 to 1.48)	⊕⊕⊕⊖ MODERATE^d	1.72 (1.44 to 2.06)	⊕⊕⊕⊖ MODERATE^f	640 per 1000	922 per 1000	282 more per 1,000 (from 186 more to 397 more)
Dilation and curettage	1.49 (1.26 to 1.75)	⊕⊕⊖⊖ LOW^c	1.25 (1.12 to 1.39)	⊕⊕⊕⊖ MODERATE^e	1.55 (1.29 to 1.86)	⊕⊕⊖⊖ LOW^b	640 per 1000	954 per 1000	314 more per 1,000 (from 166 more to 480 more)
Mifepristone plus misoprostol	1.42 (1.22 to 1.66)	⊕⊕⊕⊖ MODERATE^g	1.59 (1.01 to 2.51)	⊕⊕⊕⊖ MODERATE^d	1.40 (1.16 to 1.70)	⊕⊕⊕⊖ MODERATE^f	640 per 1000	909 per 1000	269 more per 1,000 (from 141 more to 422 more)
Misoprostol	1.30 (1.16 to 1.46)	⊕⊕⊖⊖ LOW^c	1.85 (1.35 to 2.55)	⊕⊕⊕⊖ MODERATE^d	1.14 (0.99 to 1.31)	⊕⊕⊕⊖ MODERATE^f	640 per 1000	832 per 1000	192 more per 1,000 (from 102 more to 294 more)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect..
^a Network evidence downgraded ‐2 due to low certainty indirect evidence (no intransitivity, incoherence, or imprecision) ^b Indirect evidence downgraded ‐2 due to limitations in study design ^c Network evidence downgraded ‐2 due to moderate certainty direct evidence and incoherence between direct and indirect estimates (no intransitivity, or imprecision) ^d Direct evidence downgraded ‐1 due to severe unexplained statistical heterogeneity ^e Direct evidence downgraded ‐1 due to serious imprecision ^f Indirect evidence downgraded ‐1 due to severe unexplained statistical heterogeneity ^g Network evidence downgraded ‐1 due to moderate certainty indirect evidence (no intransitivity, incoherence, or imprecision)

Summary of findings 1. Complete miscarriage

Ir a la tabla de la revisión

Summary of findings 2. Complete miscarriage (missed miscarriage subgroup)

Medical and surgical management compared with expectant management or placebo for treating missed early miscarriage
Patient or population: women with missed miscarriage at ≤14 weeks gestation Settings: hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: complete miscarriage
Intervention	Network evidence		Direct evidence		Indirect evidence		*Illustrative comparative risks (95% CI) for NMA estimate**
Intervention	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Risk with standard care	Risk with intervention	Risk difference with intervention
Suction aspiration plus cervical preparation	Not estimable	‐	Not reported by included studies	‐	Not estimable	‐	Not estimable	Not estimable	Not estimable
Suction aspiration	2.43 (1.69 to 3.49)	⊕⊕⊕⊖ MODERATE^b	1.88 (1.68 to 2.12)	⊕⊕⊕⊕ HIGH	3.35 (1.94 to 5.81)	⊕⊖⊖⊖ VERY LOW^a	455 per 1000	942 per 1000	487 more per 1000 (from 402 more to 580 more)
Dilation and curettage	2.07 (1.19 to 3.59)	⊕⊕⊕⊕ HIGH	Not reported by included studies	‐	Not estimable	‐	455 per 1000	1000 per 1000	545 more per 1000 (from 313 more to 847 more)
Mifepristone plus misoprostol	1.82 (1.28 to 2.58)	⊕⊕⊕⊖ MODERATE^b	1.25 (1.09 to 1.45)	⊕⊕⊕⊕ HIGH	2.40 (1.58 to 3.65)	⊕⊕⊕⊖ MODERATE^c	455 per 1000	828 per 1000	373 more per 1000 (from 127 more to 719 more)
Misoprostol	1.67 (1.18 to 2.37)	⊕⊕⊖⊖ LOW^e	3.18 (1.48 to 6.85)	⊕⊕⊕⊖ MODERATE^d	1.16 (0.81 to 1.67)	⊕⊕⊕⊖ MODERATE^c	455 per 1000	760 per 1000	305 more per 1000 (from 82 more to 623 more)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a Indirect evidence downgraded ‐3 due to multiple crucial limitations in study design, severe unexplained statistical heterogeneity and imprecision ^b Network evidence downgraded ‐1 due to high certainty direct evidence and incoherence between direct and indirect estimates (no intransitivity, or imprecision) ^c Indirect evidence downgraded ‐1 due to severe unexplained statistical heterogeneity ^d Direct evidence downgraded ‐1 due to severe unexplained statistical heterogeneity ^e Network evidence downgraded ‐2 due to moderate certainty indirect evidence and incoherence between direct and indirect estimates (no intransitivity, or imprecision)

Summary of findings 2. Complete miscarriage (missed miscarriage subgroup)

Ir a la tabla de la revisión

Summary of findings 3. Complete miscarriage (incomplete miscarriage subgroup)

Medical and surgical management compared with expectant management or placebo for treating incomplete early miscarriage
Patient or population: women with incomplete miscarriage at ≤14 weeks gestation Settings: hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: complete miscarriage
Intervention	Network evidence		Direct evidence		Indirect evidence		*Illustrative comparative risks (95% CI) for NMA estimate**
Intervention	Relative effect (95% CI)	Quality of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Risk with standard care	Risk with intervention	Risk difference with intervention
Suction aspiration plus cervical preparation	Not estimable	‐	Not reported by included studies	‐	Not estimable	‐	Not estimable	Not estimable	Not estimable
Suction aspiration	1.19 (1.09 to 1.31)	⊕⊕⊕⊖ MODERATE^c	1.20 (0.85 to 1.69)	⊕⊖⊖⊖ VERY LOW^a	1.28 (1.11 to 1.48)	⊕⊕⊖⊖ LOW^b	767 per 1000	913 per 1000	146 more per 1000 (from 69 more to 238 more)
Dilation and curettage	1.19 (1.08 to 1.31)	⊕⊕⊕⊖ MODERATE^f	1.25 (1.12 to 1.39)	⊕⊕⊕⊖ MODERATE^d	1.15 (1.02 to 1.30)	⊕⊖⊖⊖ VERY LOW^e	767 per 1000	913 per 1000	146 more per 1000 (from 61 more to 238 more)
Mifepristone plus misoprostol	1.08 (0.87 to 1.34)	⊕⊖⊖⊖ VERY LOW^h	1.08 (0.90 to 1.30)	⊕⊖⊖⊖ VERY LOW^g	Not estimable	‐	767 per 1000	828 per 1000	61 more per 1000 (from 100 fewer to 261 more)
Misoprostol	1.14 (1.03 to 1.25)	⊕⊕⊕⊖ MODERATE^j	1.04 (0.70 to 1.54)	⊕⊕⊖⊖ LOWⁱ	1.12 (1.02 to 1.24)	⊕⊖⊖⊖ VERY LOW^e	767 per 1000	874 per 1000	107 more per 1000 (from 23 more to 192 more)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a Direct evidence downgraded ‐3 due to multiple crucial limitations in study design, severe unexplained statistical heterogeneity and imprecision ^b Indirect evidence downgraded ‐2 due to serious imprecision ^c Network evidence downgraded ‐1 due to low certainty indirect evidence upgraded by 1 as it was downgraded for imprecision ^d Direct evidence downgraded ‐1 due to serious imprecision ^e Indirect evidence downgraded ‐3 due to multiple crucial limitations in study design, severe unexplained statistical heterogeneity and imprecision ^f Network evidence downgraded ‐1 due to moderate certainty direct evidence (no intransitivity, incoherence, or imprecision) ^g Direct evidence downgraded ‐3 due to multiple crucial limitations in study design and imprecision ^h Network evidence downgraded ‐3 due to very low certainty direct evidence (no intransitivity, incoherence, or imprecision) ⁱ Direct evidence downgraded ‐2 due to serious imprecision ^j Network evidence downgraded ‐1 due to low certainty direct evidence upgraded by 1 as network evidence is precise

Summary of findings 3. Complete miscarriage (incomplete miscarriage subgroup)

Ir a la tabla de la revisión

Summary of findings 4. Composite outcome of death or serious complication

Medical and surgical management compared with expectant management or placebo for treating early miscarriage
Patient or population: women with missed or incomplete miscarriage at ≤14 weeks gestation Settings: Hospital Intervention: multiple interventions (suction aspiration, misoprostol, dilation plus curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management Outcome: composite outcome of death or serious complication
Intervention	Network evidence		Direct evidence		Indirect evidence		*Illustrative comparative risks (95% CI) for NMA estimate**
Intervention	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Risk with standard care	Risk with intervention	Risk difference with intervention
Suction aspiration plus cervical preparation	Not reported by included studies	‐	Not reported by included studies	‐	Not reported by included studies	‐	Not estimable	Not estimable	Not estimable
Suction aspiration	0.55 (0.23 to 1.32)	⊕⊕⊖⊖ LOW^c	0.43 (0.12 to 1.53)	⊕⊕⊖⊖ LOW^a	0.97 (0.21 to 4.40)	⊕⊕⊖⊖ LOW^b	19 per 1000	10 per 1000	9 fewer per 1000 (from 15 fewer to 6 more)
Dilation and curettage	0.43 (0.17 to 1.06)	⊕⊕⊖⊖ LOW^d	Not reported by included studies	‐	0.43 (0.17 to 1.06)	⊕⊕⊖⊖ LOW^b	19 per 1000	8 per 1000	11 fewer per 1000 (from 16 fewer to 1 more)
Mifepristone plus misoprostol	0.76 (0.31 to 1.84)	⊕⊕⊖⊖ LOW^c	0.46 (0.13 to 1.63)	⊕⊕⊖⊖ LOW^a	1.38 (0.37 to 5.17)	⊕⊕⊖⊖ LOW^b	19 per 1000	14 per 1000	5 fewer per 1000 (from 13 fewer to 16 more)
Misoprostol	0.50 (0.22 to 1.15)	⊕⊕⊖⊖ LOW^d	0.96 (0.06 to 15.08)	⊕⊕⊖⊖ LOW^a	0.35 (0.13 to 0.97)	⊕⊕⊖⊖ LOW^b	19 per 1000	10 per 1000	9 fewer per 1000 (from 15 fewer to 3 more)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a Direct evidence downgraded ‐2 due to very serious imprecision ^b Indirect evidence downgraded ‐2 due to very serious imprecision ^c Network evidence downgraded ‐2 due to low certainty direct evidence (no intransitivity or incoherence) ^d Network evidence downgraded ‐2 due to low certainty indirect evidence (no intransitivity or incoherence)

Summary of findings 4. Composite outcome of death or serious complication

Ir a la tabla de la revisión

Summary of findings 5. Need for unplanned/emergency surgical procedure

Medical and surgical management compared with expectant management or placebo for treating early miscarriage
Patient or population: women with a miscarriage at ≤14 weeks gestation Settings: hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: need for unplanned/emergency surgical procedure
Intervention	Network evidence		Direct evidence		Indirect evidence		*Illustrative comparative risks (95% CI) for NMA estimate**
Intervention	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Risk with standard care	Risk with intervention	Risk difference with intervention
Suction aspiration plus cervical preparation	Not estimable	‐	Not reported by included studies	‐	Not estimable	‐	Not estimable	Not estimable	Not estimable
Suction aspiration	0.37 (0.22 to 0.65)	⊕⊕⊕⊖ MODERATE^b	0.51 (0.30 to 0.87)	⊕⊕⊕⊕ HIGH	0.13 (0.05 to 0.35)	⊕⊕⊖⊖ LOW^a	120 per 1000	44 per 1000	76 fewer per 1000 (from 42 fewer to 94 fewer)
Dilation and curettage	0.80 (0.09 to 7.02)	⊕⊖⊖⊖ VERY LOW^c	Not reported by included studies	‐	Not estimable	‐	120 per 1000	96 per 1000	24 fewer per 1000 (from 109 fewer to 722 more)
Mifepristone plus misoprostol	0.64 (0.33 to 1.23)	⊕⊕⊖⊖ LOW^e	0.32 (0.11 to 0.90)	⊕⊕⊕⊖ MODERATE^d	0.91 (0.43 to 1.93)	⊕⊕⊖⊖ LOW^a	120 per 1000	77 per 1000	43 less per 1000 (from 80 fewer to 28 more)
Misoprostol	1.04 (0.56 to 1.95)	⊕⊕⊖⊖ LOW^g	0.67 (0.23 to 1.95)	⊕⊕⊖⊖ LOW^f	1.28 (0.61 to 2.66)	⊕⊕⊖⊖ LOW^a	120 per 1000	125 per 1000	5 more per 1000 (from 53 fewer to 114 more)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a Indirect evidence downgraded ‐2 due to serious imprecision ^b Network evidence downgraded ‐1 due to high certainty direct evidence downgraded due to incoherence ^c Network evidence downgraded ‐1 due to low certainty indirect loop further downgraded due to imprecision ^d Direct evidence downgraded ‐1 due to imprecision ^e Network evidence downgraded ‐1 due to moderate certainty direct evidence downgraded due to incoherence ^f Direct evidence downgraded ‐2 due to serious imprecision ^g Network evidence downgraded due to low certainty indirect evidence with imprecision but not further downgraded as indirect evidence previously downgraded for imprecision

Summary of findings 5. Need for unplanned/emergency surgical procedure

Ir a la tabla de la revisión

Summary of findings 6. Pain scores (visual analogue scale)

Intervention	*Anticipated absolute effects^ (95% CI)**		№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Medical and surgical management compared with expectant management or placebo for treating early miscarriage
Patient or population: women with a miscarriage at ≤14 weeks gestation Settings: hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: pain scores (visual analogue scale)
Intervention	Risk with standard care	Risk with intervention	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Suction aspiration plus cervical preparation	The mean pain score was 0	Not reported by included studies	‐	‐
Suction aspiration	The mean pain score was 0	Not reported by included studies	‐	‐
Dilation and curettage	The mean pain score was 0	Not reported by included studies	‐	‐
Mifepristone plus misoprostol	The pain score in the mifepristone plus misoprostol group was on average 0.14 higher (from 0.21 lower to 0.5 higher) than in the expectant management or placebo group		122 (1 RCT)	⊕⊕⊝⊝ LOW ^a,b	small effect
Misoprostol	The pain score in the misoprostol group was on average 0.33 higher (from 0.08 lower to 0.57 higher) than in the expectant management or placebo group		262 (3 RCTs)	⊕⊕⊝⊝ LOW ^a,b	small effect
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a ‐1 as patient reported outcome ^b ‐1 due to imprecision

Summary of findings 6. Pain scores (visual analogue scale)

Ir a la tabla de la revisión

Summary of findings 7. Pelvic inflammatory disease, sepsis or endometritis

Medical and surgical management compared with expectant management or placebo for treating early miscarriage
Patient or population: women with a miscarriage at ≤14 weeks gestation Settings: Hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: pelvic inflammatory disease, sepsis or endometritis
Intervention	Network evidence		Direct evidence		Indirect evidence		*Illustrative comparative risks (95% CI) for NMA estimate**
Intervention	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Relative effect (95% CI)	Certainty of the evidence (GRADE)	Risk with standard care	Risk with intervention	Risk difference with intervention
Suction aspiration plus cervical preparation	Not estimable	‐	Not reported by included studies	‐	Not estimable	‐	Not estimable	Not estimable	Not estimable
Suction aspiration	1.42 (0.88 to 2.28)	⊕⊕⊕⊖ MODERATE^c	1.35 (0.76 to 2.41)	⊕⊕⊕⊖ MODERATE^a	1.55 (0.66 to 3.68)	⊕⊕⊖⊖ LOW^b	36 per 1000	51 per 1000	15 more per 1000 (from 4 fewer to 46 more)
Dilation and curettage	1.85 (1.05 to 3.25)	⊕⊖⊖⊖ VERY LOW^f	3.30 (0.82 to 13.28)	⊕⊕⊖⊖ LOW^d	1.65 (0.89 to 3.06)	⊕⊖⊖⊖ VERY LOW^e	36 per 1000	67 per 1000	31 more 1000 (from 2 more to 81 more)
Mifepristone plus misoprostol	0.90 (0.48 to 1.68)	⊕⊕⊖⊖ LOW^g	0.73 (0.30 to 1.80)	⊕⊕⊖⊖ LOW^d	1.11 (0.47 to 2.64)	⊕⊕⊖⊖ LOW^b	36 per 1000	32 per 1000	4 fewer per 1000 (from 19 fewer to 25 more)
Misoprostol	1.08 (0.62 to 1.88)	⊕⊕⊕⊖ MODERATE^c	1.84 (0.35 to 9.68)	⊕⊕⊖⊖ LOW^d	1.10 (0.56 to 2.16)	⊕⊕⊕⊖ MODERATE^h	36 per 1000	39 per 1000	3 more per 1000 (from 14 fewer to 32 more)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a Direct evidence downgraded ‐1 due to imprecision ^b Indirect evidence downgraded ‐2 due to serious imprecision ^c Network evidence downgraded ‐1 due to moderate certainty direct evidence not further downgraded due to imprecision as direct evidence previously downgraded for imprecision ^d Direct evidence downgraded ‐2 due to serious imprecision ^e Indirect evidence downgraded ‐3 due to serious design limitations and imprecision in direct evidence ^f Network evidence downgraded ‐3 due to very low certainty indirect evidence, further downgraded ‐1 for incoherence but upgraded +1 as network is precise ^g Network evidence downgraded ‐2 due to low certainty direct evidence, not further downgraded due to imprecision as direct evidence previously downgraded for imprecision ^h Indirect evidence downgraded ‐1 due to imprecision in direct evidence

Summary of findings 7. Pelvic inflammatory disease, sepsis or endometritis

Ir a la tabla de la revisión

Summary of findings 8. Days of bleeding

Medical and surgical management compared with expectant management or placebo for treating early miscarriage
Patient or population: women with a miscarriage at ≤14 weeks gestation Settings: hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: days of bleeding
Intervention	Network evidence		Direct evidence		Indirect evidence		*Illustrative comparative risks (95% CI) for NMA estimate**
Intervention	Mean difference (95% CI)	Certainty of the evidence (GRADE)	Mean difference (95% CI)	Certainty of the evidence (GRADE)	Mean difference (95% CI)	Certainty of the evidence (GRADE)	Risk with standard care	Risk with intervention	Risk difference with intervention
Suction aspiration plus cervical preparation	Not estimable	‐	Not reported by included studies	‐	Not estimable	‐	Not estimable	Not estimable	Not estimable
Suction aspiration	‐2.00 (‐3.01 to ‐0.99)	⊕⊖⊖⊖ VERY LOW^c	‐2.75 (‐4.08 to ‐1.42)	⊕⊕⊖⊖ LOW^a	‐0.73 (‐2.12 to 0.66)	⊕⊖⊖⊖ VERY LOW^b	10 days	8 days	2 days less (from 0.99 days less to 3.01 days less)
Dilation and curettage	‐1.96 (‐3.48 to ‐0.45)	⊕⊕⊖⊖ LOW^f	‐1.26 (‐2.27 to ‐0.25)	⊕⊕⊖⊖ LOW^d	‐2.47 (‐4.47 to ‐0.46)	⊕⊖⊖⊖ VERY LOW^e	10 days	8.04 days	1.96 days less (from 0.45 days less to 3.48 days less)
Mifepristone plus misoprostol	‐0.14 (‐1.71 to 1.43)	⊕⊖⊖⊖ VERY LOW^h	0.70 (‐0.43 to 1.83)	⊕⊖⊖⊖ VERY LOW^g	‐0.77 (‐2.83 to 1.30)	⊕⊖⊖⊖ VERY LOW^b	10 days	9.86 days	0.14 days less (from 1.71 days less to 1.43 days more)
Misoprostol	‐0.47 (‐1.53 to 0.60)	⊕⊖⊖⊖ VERY LOW^k	0.32 (‐2.19 to 2.84)	⊕⊖⊖⊖ VERY LOWⁱ	‐0.96 (‐2.27 to 0.35)	⊕⊕⊖⊖ LOW^j	10 days	9.53 days	0.47 days less (from 1.53 days less to 0.60 days more)
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a Direct evidence downgraded ‐2 due to patient reported outcome and significant heterogeneity ^b Indirect evidence downgraded ‐4 due to patient reported outcome, significant heterogeneity and serious imprecision ^c Network evidence downgraded ‐4 due to low certainty direct evidence, further downgraded due to incoherence and not upgraded as direct grade not downgraded for imprecision ^d Direct evidence downgraded ‐2 due to patient reported outcome and imprecision ^e Indirect evidence downgraded ‐4 due to very low certainty direct evidence which was due to patient reported outcome, moderate design limitations and serious imprecision ^f Network evidence downgraded ‐2 due to low certainty direct evidence, further downgraded ‐1 for incoherence but upgraded +1 as network is precise and direct evidence was previously downgraded for imprecision ^g Direct evidence downgraded ‐3 due to patient reported outcome and serious imprecision ^h Network evidence downgraded ‐5 due to very low certainty direct evidence, further downgraded due to incoherence but not even further downgraded due to imprecision as direct evidence previously downgraded for imprecision ⁱ Direct evidence downgraded ‐4 due to patient reported outcome, significant heterogeneity and serious imprecision ^j Indirect evidence downgraded ‐2 due to patient reported outcome and significant heterogeneity ^k Network evidence downgraded ‐3 due to low certainty indirect evidence downgraded ‐1 due to imprecision

Summary of findings 8. Days of bleeding

Ir a la tabla de la revisión

Summary of findings 9. Women’s views/satisfaction

Intervention	Narrative synthesis	№ of participants (studies)	Certainty of the evidence (GRADE)
Medical and surgical management compared with expectant management or placebo for treating early miscarriage
Patient or population: women with a miscarriage at ≤14 weeks gestation Settings: hospital or other healthcare facility Intervention: multiple interventions (suction aspiration, misoprostol, dilation and curettage, mifepristone plus misoprostol, suction aspiration plus cervical preparation) Comparison (reference): expectant management or placebo Outcome: women's views/ satisfaction
Suction aspiration plus cervical preparation	Not reported by included studies	(0 RCTs)	‐
Suction aspiration	2 trials described 92 out of 96 women (98.5%) as being satisfied with suction aspiration compared to 97 out of 99 women (98.0%) for expectant management or placebo. 1 trial used a 10 point numerical scale and found suction aspiration had a satisfaction score of 7.57 from 175 women and expectant management or placebo also had a 7.57 score from 177 women.	547 (3 RCTs)	⊕⊕⊕⊝ MODERATE^a
Dilatation and curettage	Not reported by included studies	(0 RCTs)	‐
Mifepristone plus misoprostol	1 trial used a visual analogue scale and found Mifepristone plus misoprostol had a score of 28.6 (SD 24.8) from 60 women compared to 25.2 (SD 25.6) from 62 women for expectant management or placebo	122 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^a,b,c
Misoprostol	1 trial used a visual analogue scale and found misoprostol had a score of 8.9 (+/‐ 1.3) compared to 8.7 (+/‐ 1.5) for expectant management or placebo with 52 women in each arm. 1 trial described 14 out of 16 (87.5%) women as being satisfied with misoprostol compared to 12 out of 16 (75%) women as being satisfied with expectant management or placebo	136 (2 RCTs)	⊕⊕⊝⊝ LOW^a,c
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
^a‐1 no meta‐analysis possible, narrative synthesis was conducted, estimates are not precise ^b ‐1 due to design limitations ^c ‐1 due to imprecision

Summary of findings 9. Women’s views/satisfaction

Ir a la tabla de la revisión

Comparison 1. Suction aspiration vs Misoprostol

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Complete Miscarriage Show forest plot	23		Risk Ratio (IV, Random, 95% CI)	Subtotals only

1.1.1 Missed miscarriage	3	308	Risk Ratio (IV, Random, 95% CI)	1.51 [1.14, 2.01]
1.1.2 Incomplete miscarriage	14	3474	Risk Ratio (IV, Random, 95% CI)	1.03 [1.01, 1.05]
1.1.3 Mixed population	6	1706	Risk Ratio (IV, Random, 95% CI)	1.19 [1.06, 1.32]
1.2 Composite outcome of death or serious complication Show forest plot	9	2146	Risk Ratio (IV, Random, 95% CI)	1.53 [0.45, 5.16]

1.3 Need for unplanned/emergency surgical procedure Show forest plot	9	1078	Risk Ratio (IV, Random, 95% CI)	0.19 [0.10, 0.37]

1.4 Pain score Show forest plot	8	2857	Std. Mean Difference (IV, Random, 95% CI)	0.08 [‐0.35, 0.51]

1.5 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	12	2989	Risk Ratio (IV, Random, 95% CI)	1.27 [0.67, 2.41]

1.6 Change in haemoglobin measurements before and after the miscarriage Show forest plot	7	2706	Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.29, ‐0.05]

1.7 Days of bleeding Show forest plot	7		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.8 Cervical tear Show forest plot	5	1252	Risk Ratio (IV, Random, 95% CI)	7.18 [0.84, 61.00]

1.9 Mean duration of hospital stay (days) Show forest plot	1	635	Mean Difference (IV, Random, 95% CI)	‐0.40 [‐0.68, ‐0.12]

1.10 Re‐admission to hospital Show forest plot	2	554	Risk Ratio (IV, Random, 95% CI)	0.77 [0.27, 2.21]

1.11 Nausea Show forest plot	13	3605	Risk Ratio (IV, Random, 95% CI)	0.52 [0.35, 0.76]

1.12 Vomiting Show forest plot	13	3447	Risk Ratio (IV, Random, 95% CI)	0.50 [0.38, 0.68]

1.13 Diarrhoea Show forest plot	9	1769	Risk Ratio (IV, Random, 95% CI)	0.39 [0.26, 0.60]

1.14 Pyrexia Show forest plot	15	4129	Risk Ratio (IV, Random, 95% CI)	0.37 [0.22, 0.61]

1.15 Anxiety score Show forest plot	2	719	Std. Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.24, 0.09]

1.16 Depression score Show forest plot	2	719	Std. Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.46, 0.12]

Comparison 1. Suction aspiration vs Misoprostol

Ir a la tabla de la revisión

Comparison 2. Suction aspiration vs Mifepristone + Misoprostol

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Complete Miscarriage Show forest plot	2		Risk Ratio (IV, Random, 95% CI)	Subtotals only

2.1.1 Missed miscarriage	1	618	Risk Ratio (IV, Random, 95% CI)	1.50 [1.37, 1.64]
2.1.2 Mixed population	1	98	Risk Ratio (IV, Random, 95% CI)	1.11 [1.01, 1.23]
2.2 Composite outcome of death or serious complication Show forest plot	1	618	Risk Ratio (IV, Random, 95% CI)	0.14 [0.01, 2.74]

2.3 Need for unplanned/emergency surgical procedure Show forest plot	1	98	Risk Ratio (IV, Random, 95% CI)	1.00 [0.06, 15.54]

2.4 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	2	716	Risk Ratio (IV, Random, 95% CI)	2.33 [0.47, 11.44]

2.5 Re‐admission to hospital Show forest plot	1	98	Risk Ratio (IV, Random, 95% CI)	0.14 [0.01, 2.69]

Comparison 2. Suction aspiration vs Mifepristone + Misoprostol

Ir a la tabla de la revisión

Comparison 3. Suction aspiration vs Dilatation & Curettage

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Complete Miscarriage Show forest plot	5		Risk Ratio (IV, Random, 95% CI)	Subtotals only

3.1.1 Incomplete miscarriage	4	1432	Risk Ratio (IV, Random, 95% CI)	1.02 [0.98, 1.06]
3.1.2 Mixed population	1	90	Risk Ratio (IV, Random, 95% CI)	1.05 [0.94, 1.17]
3.2 Composite outcome of death or serious complication Show forest plot	5	1521	Risk Ratio (IV, Random, 95% CI)	1.27 [0.80, 2.02]

3.3 Need for unplanned/emergency surgical procedure Show forest plot	2	693	Risk Ratio (IV, Random, 95% CI)	0.33 [0.01, 8.07]

3.4 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	3	822	Risk Ratio (IV, Random, 95% CI)	0.77 [0.53, 1.11]

3.5 Mean volumes of blood loss (millilitres) Show forest plot	2	451	Mean Difference (IV, Random, 95% CI)	‐11.44 [‐21.49, ‐1.40]

3.6 Change in haemoglobin measurements before and after the miscarriage Show forest plot	2	370	Mean Difference (IV, Random, 95% CI)	‐0.41 [‐0.68, ‐0.14]

3.7 Days of bleeding Show forest plot	1	270	Mean Difference (IV, Random, 95% CI)	‐0.30 [‐1.30, 0.70]

3.8 Cervical tear Show forest plot	2	558	Risk Ratio (IV, Random, 95% CI)	0.49 [0.20, 1.18]

3.9 Mean duration of hospital stay (days) Show forest plot	3	220	Mean Difference (IV, Random, 95% CI)	‐0.56 [‐0.89, ‐0.23]

3.10 Re‐admission to hospital Show forest plot	2	1042	Risk Ratio (IV, Random, 95% CI)	1.61 [0.62, 4.16]

3.11 Vomiting Show forest plot	1	599	Risk Ratio (IV, Random, 95% CI)	2.31 [0.60, 8.85]

3.12 Pyrexia Show forest plot	3	1157	Risk Ratio (IV, Random, 95% CI)	1.31 [0.85, 2.02]

Comparison 3. Suction aspiration vs Dilatation & Curettage

Ir a la tabla de la revisión

Comparison 4. Suction aspiration vs Expectant/ Placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Complete Miscarriage Show forest plot	7		Risk Ratio (IV, Random, 95% CI)	Subtotals only

4.1.1 Missed miscarriage	1	616	Risk Ratio (IV, Random, 95% CI)	1.88 [1.68, 2.12]
4.1.2 Incomplete miscarriage	2	300	Risk Ratio (IV, Random, 95% CI)	1.20 [0.85, 1.69]
4.1.3 Mixed population	4	776	Risk Ratio (IV, Random, 95% CI)	1.18 [1.11, 1.25]
4.2 Composite outcome of death or serious complication Show forest plot	5	1485	Risk Ratio (IV, Random, 95% CI)	0.43 [0.12, 1.53]

4.3 Need for unplanned/emergency surgical procedure Show forest plot	4	842	Risk Ratio (IV, Random, 95% CI)	0.51 [0.30, 0.87]

4.4 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	8	1725	Risk Ratio (IV, Random, 95% CI)	1.35 [0.76, 2.41]

4.5 Mean volumes of blood loss (millilitres) Show forest plot	1	352	Mean Difference (IV, Random, 95% CI)	‐23.00 [‐40.41, ‐5.59]

4.6 Change in haemoglobin measurements before and after the miscarriage Show forest plot	3	603	Mean Difference (IV, Random, 95% CI)	0.18 [0.10, 0.25]

4.7 Days of bleeding Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.8 Cervical tear Show forest plot	2	492	Risk Ratio (IV, Random, 95% CI)	Not estimable

4.9 Mean duration of hospital stay (days) Show forest plot	1	140	Mean Difference (IV, Random, 95% CI)	0.99 [0.74, 1.24]

4.10 Re‐admission to hospital Show forest plot	2	463	Risk Ratio (IV, Random, 95% CI)	0.72 [0.15, 3.41]

4.11 Vomiting Show forest plot	1	111	Risk Ratio (IV, Random, 95% CI)	0.82 [0.19, 3.50]

4.12 Diarrhoea Show forest plot	1	111	Risk Ratio (IV, Random, 95% CI)	1.82 [0.71, 4.67]

4.13 Pyrexia Show forest plot	1	111	Risk Ratio (IV, Random, 95% CI)	3.28 [0.69, 15.57]

4.14 Anxiety score Show forest plot	1	111	Std. Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.49, 0.26]

4.15 Depression score Show forest plot	1	111	Std. Mean Difference (IV, Random, 95% CI)	‐0.29 [‐0.67, 0.08]

Comparison 4. Suction aspiration vs Expectant/ Placebo

Ir a la tabla de la revisión

Comparison 5. Misoprostol vs Mifepristone + Misoprostol

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 Complete Miscarriage Show forest plot	7		Risk Ratio (IV, Random, 95% CI)	Subtotals only

5.1.1 Missed miscarriage	7	1812	Risk Ratio (IV, Random, 95% CI)	0.87 [0.79, 0.97]
5.2 Composite outcome of death or serious complication Show forest plot	7	1822	Risk Ratio (IV, Random, 95% CI)	0.50 [0.20, 1.25]

5.3 Need for unplanned/emergency surgical procedure Show forest plot	6	1527	Risk Ratio (IV, Random, 95% CI)	1.55 [1.22, 1.96]

5.4 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	5	1617	Risk Ratio (IV, Random, 95% CI)	1.02 [0.54, 1.92]

5.5 Change in haemoglobin measurements before and after the miscarriage Show forest plot	1	90	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.18, 0.22]

5.6 Days of bleeding Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Subtotals only

5.7 Re‐admission to hospital Show forest plot	1	344	Risk Ratio (IV, Random, 95% CI)	2.30 [1.48, 3.58]

5.8 Nausea Show forest plot	2	570	Risk Ratio (IV, Random, 95% CI)	0.74 [0.39, 1.39]

5.9 Vomiting Show forest plot	1	300	Risk Ratio (IV, Random, 95% CI)	0.57 [0.36, 0.90]

5.10 Diarrhoea Show forest plot	2	570	Risk Ratio (IV, Random, 95% CI)	1.09 [0.83, 1.44]

5.11 Pyrexia Show forest plot	4	685	Risk Ratio (IV, Random, 95% CI)	0.74 [0.34, 1.62]

Comparison 5. Misoprostol vs Mifepristone + Misoprostol

Ir a la tabla de la revisión

Comparison 6. Misoprostol vs Dilatation & Curettage

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 Complete Miscarriage Show forest plot	4		Risk Ratio (IV, Random, 95% CI)	Subtotals only

6.1.1 Missed miscarriage	1	107	Risk Ratio (IV, Random, 95% CI)	0.81 [0.71, 0.93]
6.1.2 Incomplete miscarriage	1	94	Risk Ratio (IV, Random, 95% CI)	0.92 [0.83, 1.01]
6.1.3 Mixed population	2	154	Risk Ratio (IV, Random, 95% CI)	0.32 [0.07, 1.47]
6.2 Composite outcome of death or serious complication Show forest plot	2	157	Risk Ratio (IV, Random, 95% CI)	1.26 [0.54, 2.97]

6.3 Need for unplanned/emergency surgical procedure Show forest plot	1	94	Risk Ratio (IV, Random, 95% CI)	Not estimable

6.4 Pain score Show forest plot	1	94	Std. Mean Difference (IV, Random, 95% CI)	0.51 [0.10, 0.92]

6.5 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	2	201	Risk Ratio (IV, Random, 95% CI)	2.12 [0.20, 22.64]

6.6 Mean volumes of blood loss (millilitres) Show forest plot	1	104	Mean Difference (IV, Random, 95% CI)	22.30 [4.45, 40.15]

6.7 Days of bleeding Show forest plot	1	94	Mean Difference (IV, Random, 95% CI)	2.60 [1.27, 3.93]

6.8 Cervical tear Show forest plot	1	107	Risk Ratio (IV, Random, 95% CI)	Not estimable

6.9 Re‐admission to hospital Show forest plot	1	107	Risk Ratio (IV, Random, 95% CI)	3.17 [0.13, 76.11]

6.10 Vomiting Show forest plot	1	94	Risk Ratio (IV, Random, 95% CI)	0.33 [0.01, 7.98]

6.11 Nausea Show forest plot	1	94	Risk Ratio (IV, Random, 95% CI)	0.33 [0.01, 7.98]

6.12 Diarrhoea Show forest plot	1	94	Risk Ratio (IV, Random, 95% CI)	3.00 [0.13, 71.82]

6.13 Depression score Show forest plot	1	215	Std. Mean Difference (IV, Random, 95% CI)	‐0.09 [‐0.36, 0.18]

Comparison 6. Misoprostol vs Dilatation & Curettage

Ir a la tabla de la revisión

Comparison 7. Misoprostol vs Suction aspiration + Cervical preparation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 Complete Miscarriage Show forest plot	1		Risk Ratio (IV, Random, 95% CI)	Subtotals only

7.2 Pyrexia Show forest plot	1	200	Risk Ratio (IV, Random, 95% CI)	2.50 [0.81, 7.71]

Comparison 7. Misoprostol vs Suction aspiration + Cervical preparation

Ir a la tabla de la revisión

Comparison 8. Misoprostol vs Expectant/ Placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
8.1 Complete Miscarriage Show forest plot	10		Risk Ratio (IV, Random, 95% CI)	Subtotals only

8.1.1 Missed miscarriage	4	322	Risk Ratio (IV, Random, 95% CI)	3.18 [1.48, 6.85]
8.1.2 Incomplete miscarriage	2	108	Risk Ratio (IV, Random, 95% CI)	1.91 [0.44, 8.20]
8.1.3 Mixed population	4	408	Risk Ratio (IV, Random, 95% CI)	1.45 [0.97, 2.16]
8.2 Composite outcome of death or serious complication Show forest plot	6	548	Risk Ratio (IV, Random, 95% CI)	0.96 [0.06, 15.08]

8.3 Need for unplanned/emergency surgical procedure Show forest plot	5	437	Risk Ratio (IV, Random, 95% CI)	0.67 [0.23, 1.95]

8.4 Pain score Show forest plot	3	262	Std. Mean Difference (IV, Random, 95% CI)	0.33 [0.08, 0.57]

8.5 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	6	615	Risk Ratio (IV, Random, 95% CI)	1.84 [0.35, 9.68]

8.6 Change in haemoglobin measurements before and after the miscarriage Show forest plot	2	167	Mean Difference (IV, Random, 95% CI)	0.15 [‐0.21, 0.52]

8.7 Days of bleeding Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

8.8 Mean duration of hospital stay (days) Show forest plot	1	184	Mean Difference (IV, Random, 95% CI)	‐0.10 [‐0.19, ‐0.01]

8.9 Re‐admission to hospital Show forest plot	3	335	Risk Ratio (IV, Random, 95% CI)	1.25 [0.46, 3.35]

8.10 Nausea Show forest plot	5	389	Risk Ratio (IV, Random, 95% CI)	1.15 [0.93, 1.42]

8.11 Vomiting Show forest plot	6	506	Risk Ratio (IV, Random, 95% CI)	1.37 [0.75, 2.52]

8.12 Diarrhoea Show forest plot	7	560	Risk Ratio (IV, Random, 95% CI)	1.69 [1.05, 2.73]

8.13 Pyrexia Show forest plot	3	275	Risk Ratio (IV, Random, 95% CI)	4.03 [1.16, 13.97]

8.14 Anxiety score Show forest plot	1	117	Std. Mean Difference (IV, Random, 95% CI)	‐0.14 [‐0.51, 0.22]

8.15 Depression score Show forest plot	1	117	Std. Mean Difference (IV, Random, 95% CI)	0.08 [‐0.29, 0.44]

Comparison 8. Misoprostol vs Expectant/ Placebo

Ir a la tabla de la revisión

Comparison 9. Dilatation & Curettage vs Expectant/ Placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
9.1 Complete Miscarriage Show forest plot	1		Risk Ratio (IV, Random, 95% CI)	Subtotals only

9.1.1 Incomplete miscarriage	1	155	Risk Ratio (IV, Random, 95% CI)	1.25 [1.12, 1.39]
9.2 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	1	155	Risk Ratio (IV, Random, 95% CI)	3.30 [0.82, 13.28]

9.3 Days of bleeding Show forest plot	1	155	Mean Difference (IV, Random, 95% CI)	‐1.26 [‐2.27, ‐0.25]

Comparison 9. Dilatation & Curettage vs Expectant/ Placebo

Ir a la tabla de la revisión

Comparison 10. Mifepristone + Misoprostol vs Expectant/ Placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
10.1 Complete Miscarriage Show forest plot	3		Risk Ratio (IV, Random, 95% CI)	Subtotals only

10.1.1 Missed miscarriage	1	614	Risk Ratio (IV, Random, 95% CI)	1.25 [1.09, 1.45]
10.1.2 Incomplete miscarriage	1	122	Risk Ratio (IV, Random, 95% CI)	1.08 [0.90, 1.30]
10.1.3 Mixed population	1	174	Risk Ratio (IV, Random, 95% CI)	3.44 [2.31, 5.11]
10.2 Composite outcome of death or serious complication Show forest plot	2	788	Risk Ratio (IV, Random, 95% CI)	0.43 [0.11, 1.63]

10.3 Need for unplanned/emergency surgical procedure Show forest plot	2	296	Risk Ratio (IV, Random, 95% CI)	0.32 [0.11, 0.90]

10.4 Pain score Show forest plot	1	122	Std. Mean Difference (IV, Random, 95% CI)	0.14 [‐0.21, 0.50]

10.5 Pelvic inflammatory disease, sepsis or endometritis Show forest plot	2	736	Risk Ratio (IV, Random, 95% CI)	0.73 [0.30, 1.80]

10.6 Days of bleeding Show forest plot	1	122	Mean Difference (IV, Random, 95% CI)	0.70 [‐0.43, 1.83]

10.7 Pyrexia Show forest plot	1	174	Risk Ratio (IV, Random, 95% CI)	0.32 [0.01, 7.71]

Comparison 10. Mifepristone + Misoprostol vs Expectant/ Placebo

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet

Scolaris Content Display Scolaris Content Display

Temas

Scolaris Language Selector Scolaris Language Selector

Scolaris Content Display Scolaris Content Display

Instituciones a las que se accedió previamente

Scolaris Content Display Scolaris Content Display

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Contenido relacionado

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Temas

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso