Abstract:
BACKGROUND:First-trimester miscarriage affects up to a quarter of women worldwide. With many competing treatment options available, there is a need for a comprehensive evidence synthesis. OBJECTIVES AND RATIONALE:We conducted a systematic review and network meta-analysis to assess the effectiveness and safety of treatment options for first-trimester miscarriage: expectant management (EXP), sharp dilation and curettage (D+C), electric vacuum aspiration (EVAC), manual vacuum aspiration (MVA), misoprostol alone (MISO), mifepristone+misoprostol (MIFE+MISO) and misoprostol plus electric vacuum aspiration (MISO+EVAC). SEARCH METHODS:We searched MEDLINE, Embase, CINAHL, AMED and Cochrane Library from inception till June 2018. We included randomized trials of women with first-trimester miscarriage (<14 weeks gestation) and conducted a network meta-analysis generating both direct and mixed evidence on the effectiveness and side effects of available treatment options. The primary outcome was complete evacuation of products of conception. We assessed the risk of bias and the global network inconsistency. We compared the surface under the cumulative ranking curve (SUCRA) for each treatment. OUTCOMES:A total of 46 trials (9250 women) were included. The quality of included studies was overall moderate with some studies demonstrating a high risk of bias. We detected unexplained inconsistency in evidence loops involving MIFE+MISO and adjusted for it. EXP had lower effectiveness compared to other treatment options. The effectiveness of medical treatments was similar compared to surgery. Mixed evidence of low confidence suggests increased effectiveness for MIFE+MISO compared to MISO alone (RR 1.49, 95% CI: 1.09-2.03). Side effects were similar among all options. Fewer women needed analgesia following EVAC compared to MISO (RR for MISO 0.43, 95% CI: 0.27-0.68) and in the EXP group compared to EVAC (RR 2.07, 95% CI: 1.25-3.41). MVA had higher ranking (low likelihood) for post-treatment infection and serious complications (SUCRA 87.6 and 79.2%, respectively) with the highest likelihood for post-treatment satisfaction (SUCRA 98%). WIDER IMPLICATIONS:Medical treatments for first-trimester miscarriage have similar effectiveness and side effects compared to surgery. The addition of MIFE could increase the effectiveness of MISO and reduce side effects, although evidence is limited due to inconsistency. EXP has lower effectiveness compared to other treatment options.Systematic review registration: Prospero CRD42016048920.
journal_name
Hum Reprod Updatejournal_title
Human reproduction updateauthors
H Al Wattar B,Murugesu N,Tobias A,Zamora J,Khan KSdoi
10.1093/humupd/dmz002subject
Has Abstractpub_date
2019-05-01 00:00:00pages
362-374issue
3eissn
1355-4786issn
1460-2369pii
5316073journal_volume
25pub_type
杂志文章,meta分析abstract::The human ovary is a dynamic organ which continually changes in size and activity through life, as an integral part of the changes that the female is going through before during and after her reproductive life. Following the rapid increase in the use of transvaginal scan in recent years, the measurement of ovarian vol...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/5.3.256
更新日期:1999-05-01 00:00:00
abstract::From a public health viewpoint, the intrauterine device (IUD) is the most widely used contraceptive method in the world. Prevalence rates range among countries from 2 to 80% of contraceptive users. During 5 years of IUD use, pregnancy occurs in less than 2 per 100 insertions. Bleeding and pain are the most common reas...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmn003
更新日期:2008-05-01 00:00:00
abstract::Mucin glycoproteins are major constituents of the glycocalyx that covers mucosal epithelium. Two broad classes of mucins exist: membrane-associated and secretory. Of the secreted mucins, those with cysteine-rich regions are thought to polymerize through disulphide bonds. Among these gel-forming mucins are MUC2, MUC5AC...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/5.4.280
更新日期:1999-07-01 00:00:00
abstract::Ovarian follicular development occurs in a hierarchical manner with each follicle having a unique biochemical composition at any moment in time. It has long been understood that a precise coordination between the growth and maturation of the oocyte and adjacent follicular cells (i.e. somatic cells) is essential in ord...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh061
更新日期:2005-03-01 00:00:00
abstract::Hormonal contraception has become more effective and more widely used, while the world population has grown from 3000 million in 1960 to 6000 million in 2000. There is a need for improved contraception, because legal abortion is used in a high proportion of pregnancies and illegal abortion continues to be common in so...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/8.4.359
更新日期:2002-07-01 00:00:00
abstract::The effects on reproductive tract development in male rats, of neonatal exposure to potent (reference) oestrogens, diethylstilboestrol (DES) and ethinyl oestradiol (EE), with those of two environmental oestrogens, octylphenol and hisphenol A were systematically compared. Other treatments, such as administration of a g...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.3.236
更新日期:2001-05-01 00:00:00
abstract::Uterine malformations consist of a group of miscellaneous congenital anomalies of the female genital system. Their mean prevalence in the general population and in the population of fertile women is approximately 4.3%, in infertile patients approximately 3.5% and in patients with recurrent pregnancy losses approximate...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.2.161
更新日期:2001-03-01 00:00:00
abstract::Operative hysteroscopy is a relatively new technique that has significantly improved the diagnosis and therapy of abnormal uterine bleeding. At first, the success of operative hysteroscopy in controlling this bleeding seemed extremely high but, with long-term follow-up, a significant failure rate became evident requir...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.4.350
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:Uterine leiomyomas (fibroids) are highly prevalent benign smooth muscle tumors of the uterus. In the USA, the lifetime risk for women developing uterine leiomyomas is estimated as up to 75%. Except for hysterectomy, most therapies or treatments often provide only partial or temporary relief and are not succe...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmv030
更新日期:2015-09-01 00:00:00
abstract::Polychlorinated dioxins, furans and polychlorinated benzene constitute a family of toxic persistent environmental pollutants. In Europe, environmental concentrations increased slowly throughout this century until the late 1980s. Dioxins have been shown to be carcinogenic in animals and humans. In humans, excess risks ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.3.331
更新日期:2001-05-01 00:00:00
abstract::Leiomyomata represent the most common gynaecological tumour in women of reproductive age, and are the primary indication for hysterectomy in the USA. Cytogenetic and genetic studies have, in recent years, advanced our understanding of the aetiology of these tumours. Cytogenetic aberrations involving chromosomes 6, 7, ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.1.8
更新日期:2001-01-01 00:00:00
abstract::Cancer treatment modalities are increasingly more effective in achieving complete remission and cure. Aggressive chemotherapy and radiotherapy, as well as bone marrow transplantation, results in >90% cure in many cancers of children and young women. As a result of this success however, a new problem has arisen. Many y...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.6.526
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:The prevalence of congenital uterine anomalies in high-risk women is unclear, as several different diagnostic approaches have been applied to different groups of patients. This review aims to evaluate the prevalence of such anomalies in unselected populations and in women with infertility, including those un...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmr028
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Mast cells (MCs) are the classical mediators of allergy, however, their importance in the development of innate and adaptive immune responses is increasingly being recognized. Herein, the present MC literature is summarized, with particular focus on studies of MCs in the endometrium and myometrium, and their...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmq053
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Monoamines play important roles in decidualization, implantation, immune modulation and inflammation. Furthermore, monoamines are potent vasoactive mediators that regulate blood flow and capillary permeability. Regulation of the uterine blood flow is important both during menstruation and pregnancy. Adequate...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmn048
更新日期:2009-03-01 00:00:00
abstract::In the male genital tract, reactive oxygen species (ROS) are generated by spermatozoa and leukocytes including neutrophils and macrophages. ROS are involved in the regulation of sperm functions such as capacitation and the acrosome reaction. Infections lead to an excessive ROS production, resulting in an 'oxidative bu...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/5.5.399
更新日期:1999-09-01 00:00:00
abstract::Amenorrhoea associated with reduced caloric intake and strenuous exercise leads to hypoestrogenism and is associated with clinical manifestations that include disordered eating, stress fractures, osteoporosis, and, as recently reported, a potential increase in the risk of premature cardiovascular disease. Disordered e...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh033
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Reproductive disorders and infertility are associated with the risk of obstetric complications and have a negative impact on pregnancy outcome. Affected patients often require assisted reproductive technologies (ART) to conceive, and advanced maternal age is a further confounding factor. The challenge is to ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmv044
更新日期:2016-01-01 00:00:00
abstract::Insulin plays a central role in human pregnancy. Maternal insulin sensitivity decreases with advancing gestation in order to provide glucose and possibly other nutrients for feto-placental growth and energy needs. Moreover, alterations of insulin metabolism are clearly involved in the development of gestational diabet...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.6.904
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:Preimplantation embryos are particularly susceptible to in vitro developmental blocks. These could be alleviated by lowering culture medium osmolarity. Because mammalian cells regulate their volumes by adjusting intracellular osmotic pressure, cell volume regulation could be critical to early embryos. METHO...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmp045
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:Recently, dopamine agonists were proposed as a prophylactic treatment for ovarian hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles. METHODS:We conducted a systematic review and meta-analysis of randomized trials comparing the prophylactic effect of the dopamine agonist, ca...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析,评审
doi:10.1093/humupd/dmq006
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:Despite great advances in assisted reproductive technology, poor ovarian response (POR) is still considered as one of the most challenging tasks in reproductive medicine. OBJECTIVE AND RATIONALE:The aim of this systemic review is to evaluate the role of different adjuvant treatment strategies on the probabi...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析
doi:10.1093/humupd/dmz046
更新日期:2020-02-28 00:00:00
abstract:BACKGROUND:Human long non-coding RNAs (lncRNAs) are an emerging category of transcripts with increasingly documented functional roles during development. LncRNAs and roles during human early embryo development have recently begun to be unravelled. OBJECTIVE AND RATIONALE:This review summarizes the most recent knowledg...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmw035
更新日期:2016-12-01 00:00:00
abstract::BACKGROUND Endometriosis associated with pain symptoms in adolescents has been extensively reported, but the exact prevalence is unclear because pain symptoms may be atypical and endometriosis can only be diagnosed by laparoscopy. The aim of this paper is to provide a systematic review of the prevalence of endometrios...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmt016
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Hirsutism is the presence of excess body or facial terminal (coarse) hair growth in females in a male-like pattern, affects 5-15% of women, and is an important sign of underlying androgen excess. Different methods are available for the assessment of hair growth in women. METHODS:We conducted a literature se...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmp024
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Androgens, FSH, anti-Müllerian hormone (AMH) and estradiol (E2) are essential in human ovarian folliculogenesis. However, the interactions between these four players is not fully understood. OBJECTIVES AND RATIONALE:The purpose of this review is to highlight the chronological sequence of the appearance and ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmw027
更新日期:2016-11-01 00:00:00
abstract::BACKGROUND To review the accuracy of multivariate models for the prediction of ovarian reserve and pregnancy in women undergoing IVF compared with the antral follicle count (AFC) as single test. METHODS We performed a computerized MEDLINE and EMBASE search to identify articles published on multivariate models for ovar...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析
doi:10.1093/humupd/dmn001
更新日期:2008-03-01 00:00:00
abstract::Pregnancy induces physiological alterations in thyroid function which may make difficult the interpretation of results of thyroid hormone measurement. A state of hyperstimulation of the thyroid gland is common in early pregnancy. In a few cases, thyroid hormone values will deviate from the normal range, which correspo...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh008
更新日期:2004-03-01 00:00:00
abstract::Cryopreservation of testicular tissue might benefit prepubertal boys who must undergo chemotherapy or radiotherapy. Cryopreservation of testicular tissue and testicular cells for intracytoplasmic sperm injection (ICSI) is feasible and widely applied. Testicular tissue from prepubertal boys can also be frozen, by apply...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.4.378
更新日期:2001-07-01 00:00:00
abstract::This review presents detailed risk estimates from relevant epidemiological and other studies on the comparative safety of second and third generation oral contraceptives (OC). Written with the intention of presenting a repository of the available information, it also discourses briefly into the symptomatology and diag...
journal_title:Human reproduction update
pub_type: 历史文章,杂志文章,评审
doi:10.1093/humupd/5.6.565
更新日期:1999-11-01 00:00:00