Impact of medical, surgical and expectant management on spontaneous miscarriage/abortion on first trimester: A systematic review and meta-analysis of randomized, controlled trials

An increase in miscarriage in the first trimester of gestation and its associated complications is burdensome on the quality of life of a woman. Medical, surgical, and expectant care are carried out after the miscarriage to remove any remaining tissues in the uterus. Understanding the efficacy and safety of these interventions will raise awareness and be a deciding factor in choosing an appropriate treatment plan. The present review aims to determine the efficacy and safety of medical, surgical, and expectant care of various medical and surgical methods for first-trimester miscarriage. This review included studies that allocated women to medical, surgical, or expectant management in the first trimester. PubMed, Cochrane Library, MEDLINE, and Embase Library were searched for the literature. The primary outcome was the complete evacuation of products of conception. Data were independently reviewed, graded for evidence quality, and assessed for risk of bias by using the guidelines of PRISMA (Preferred Report Items for Systematic Review and Meta-Analysis). Twenty-one eligible articles were included in this systematic review, comprising 7,931 patients undergoing medical, surgical, or expectant management for early spontaneous miscarriage. The success rate in surgical intervention was higher when compared with medical intervention (OR: 16.12 [9.11, 28.52]) and expectant management (OR: 2.78 [2.13, 3.61]). Whereas medical intervention had a higher success rate when compared with expectant management (OR: 4.29 [2.31, 7.97]). The review determines the effect of medical, surgical, and expectant management procedures on women who have had spontaneous miscarriages in their first trimester. PROSPERO-International prospective register of systematic reviews–CRD42020154395.