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A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14–28 weeks of gestation
Author(s) -
Cleeve Amanda,
Fønhus Marita Sporstøl,
Lavelanet Antonella
Publication year - 2019
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12964
Subject(s) - misoprostol , medicine , mifepristone , obstetrics , gestation , relative risk , randomized controlled trial , confidence interval , pregnancy , gynecology , abortion , surgery , genetics , biology
Abstract 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 To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD . Search strategy Research databases from January 2006 to October 2018. Selection criteria Randomized controlled trials with IUFD cases at 14–28 weeks of gestation. Data collection and analysis We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. Main 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 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.