Medical treatments for inevitable miscarriage.
Pregnancies that miscarry can sometimes be identified earlier at an ultrasound scan if the loss is due to the baby having died or no baby having developed. In the past, treatment before 14 weeks has usually been by surgery (D&C) but drugs have now been developed which may be helpful, or waiting for the miscarriage to happen may be a better alternative. The review of trials assessed various potential drug treatments using different routes and different doses, compared with waiting for the miscarriage. This review identified 24 studies involving 1888 women of less than 24 weeks gestation, where the baby had died in the uterus or the baby had not formed in the uterus. Most studies were of good quality. Vaginal misoprostol brought forward the time of the miscarriage, but the studies were too small to adequately assess potential adverse effects, including future fertility. Oral misoprostol seemed less effective than the vaginal route, and women took more sick-leave with the oral drugs. Some women may wish to hasten an inevitable miscarriage, and others may not. It appears that both forms of care can be available to women. Women who are breastfeeding an older baby may prefer to wait rather than have drug treatment. Further research is needed on drug doses, routes of administration and potential adverse effects, including future fertility, and also on women's views of drug treatment, surgery and waiting for spontaneous miscarriage.