Spontaneous miscarriage/abortion in the first trimester and expectant management - a meta-analysis approach

Anwesa Acharya; Ananya Prabhu; Shivali Negi; Kavya Sharma; Rinshu Dwivedi; Ramesh Athe

doi:10.5114/pm.2023.131307

Spontaneous miscarriage/abortion in the first trimester and expectant management - a meta-analysis approach

Prz Menopauzalny. 2023 Sep;22(3):135-141. doi: 10.5114/pm.2023.131307. Epub 2023 Sep 20.

Authors

Anwesa Acharya¹, Ananya Prabhu², Shivali Negi³, Kavya Sharma³, Rinshu Dwivedi⁴, Ramesh Athe⁵

Affiliations

¹ Department of Computer Science and Engineering, CMR University, Bangalore, India.
² Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, India.
³ Centre for Public Health, Punjab University, Chandigarh, India.
⁴ Department of Science and Humanities, Indian Institute of Information Technology, Tiruchirappalli, India.
⁵ Department of Data Science and Intelligent Systems, Indian Institute of Information Technology, Dharwad, India.

Abstract

Introduction: To determine effectiveness and side effects of expectant care in first-trimester miscarriage. An increase in the spontaneous miscarriage rate and its associated complications exerts a burden on the overall health and quality of life of women. Expectant care in a first-trimester miscarriage has shown success ranging 75-80%. This study was designed to search the literature for information on the clinical safety and effectiveness of expectant management on spontaneous miscarriage during the first trimester.

Material and methods: The review included studies that included women in expectant care for spontaneous miscarriage in the first trimester. Trial studies were recognized through a methodical and organized database search from PubMed, COCHRANE, MEDLINE, Embase, and bibliography from January 2000 until December 2022. The methodological assessment and risk of bias was assessed using the Joanna Briggs Institute criteria.

Results: Eleven studies in systematic review and 7 studies in the meta-analysis were included. The included studies showed a low to moderate risk of bias. The odds of success in expectant intervention were low when compared with surgical intervention (odds ratio - OR: OR: 0.37 [0.28, 0.48]) and medical management (OR: 0.47 [0.36, 0.61]), and the need for surgical evacuation was high (OR: 2.59 [1.88, 3.59]).

Conclusions: Future trials should consider women's opinions and the effect on quality of life along with clinical consequences, to provide improved suggestions on the efficiency and adverse effects.

Keywords: expectant management; first-trimester; meta-analysis; miscarriage; systematic review.