UPDATES ON MANAGEMENT OF MISSED ABORTION AND ITS PSYCHOLOGICAL OUTCOMES: A SYSTEMATIC REVIEW

Abstract

Ahmed Baker A Alshaikh*, Fawaz E Edris, Rahaf Abdulrahman E Alanaz, Raghad Faris Ismail Alsabilah, Rawan Ghazi Alsharari, Waad Abdullah A Alsharari, Shouq Hmoud Alruwaili and Renad Mohammed A Alnasser

Objectives: To study the recently published literature on the diagnosis and management of missed abortion.

Methods: We conducted a thorough search of PubMed, SCOPUS, Web of Science, and Google Scholar to find pertinent literature. Rayyan QRCI was utilized during the entire process.

Results: We included eight studies with a total of 931 participants. High antimullerian hormone (AMH) levels and low neutrophile count were demonstrated as predictive factors for missed abortion. Combining aromatase inhibitor medication (letrozole) or blocking progesterone (mifepristone) with misoprostol had favorable results than misoprostol alone regarding lower odds of non-expulsion, shorter time required for expulsion Regarding the route of administration, two studies found that vaginal misoprostol was more effective and smaller mean pain score. Transdermal electrical stimulation in conjunction with mifepristone plus methyl carboprost suppository can decrease the bleeding duration and volume, and encourage the thickening of the endometrium.

Conclusion: We found a lack of data that investigates the diagnosis and prediction of missed abortion. However, AMH level and neutrophil count were documented as significant prediction factors for the incidence of missed abortion. Misoprostol was effective in managing our condition, but combining progesterone blockade agents and aromatase inhibitors showed better responses. Additionally, vaginal misoprostol was found to be the best route of administration regarding the response and complications. Further research, especially prospective RCTs are required for better understanding and more results.