A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14-28 weeks of gestation.

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. To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. Research databases from January 2006 to October 2018. Randomized controlled trials with IUFD cases at 14-28 weeks of gestation. We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. 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. 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. © 2019 World Health Organization; licensed by International Federation of Gynecology and Obstetrics.

Citation

Amanda Cleeve, Marita Sporstøl Fønhus, Antonella Lavelanet. A systematic review of the effectiveness, safety, and acceptability of medical management of intrauterine fetal death at 14-28 weeks of gestation. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2019 Dec;147(3):301-312

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PMID: 31493314

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