Comparison of misoprostol and manual vacuum aspiration in treating first-trimester incomplete miscarriage: a systematic review and meta-analysis of randomized controlled trials

Abstract Background To provide evidence of the comparative curative efficiency and prevalence of treatment-related adverse events following manual vacuum aspiration (MVA) or misoprostol in first trimester incomplete abortion. Methods We comprehensively searched international medical literature databases, including PubMed, Medline, Ovid, Embase, and Web of science for related articles published between 2005 and 2023. After article screening, seven articles were finally included in the meta-analysis after assessment for risk of bias. Important parameters of the included studies were strictly extracted. Stata 17MP was used to compare the proportion of complete uterine evacuation, necessity for additional MVA, prevalence of adverse effects (abdominal pain, bleeding, fever, chills, nausea and vomiting), patients’ subjective evaluation and publication bias. Meta-regression was also performed. Results Seven eligible studies of 1097 patients receiving misoprostol and 1079 patients receiving MVA were included, and MVA was found to have better performance than misoprostol in terms of complete uterine evacuation (RR = 0.972, P༜0.001), regardless of age, gestational age, parity, dosage of misoprostol, and marital status. Meanwhile, misoprostol was related to higher possibility for additional MVA (RR = 7.112, P༜0.001). In terms of adverse events, misoprostol medication led to more frequent bleeding (RR = 1.91, P༜0.001), chills (RR = 7.5, P = 0.018), fever (RR = 4.34, P = 0.001), nausea (RR = 3.13, P = 0.005), and vomiting (2.21, P = 0.008). Conclusion MVA outperformed misoprostol in terms of accomplishing complete uterine evacuation in patients with first-trimester incomplete miscarriage. Moreover, the occurrence rate of adverse events was lower in MVA group than that in misoprostol group. However, since the rate of complete uterine evacuation after MVA and misoprostol were both over 90%, misoprostol was also considered as an alternative for MVA in limited resources settings. Trial registration: The research was formally registered on International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202350113) before statistical analysis.