Medical versus expectant management for retained products of conception after initial treatment for early pregnancy loss or induced abortion, a systematic review

Incomplete miscarriage is defined as residual pregnancy tissue after spontaneous or induced expulsion of the gestational sac. Typically, management options include surgical intervention, medical treatment or expectant management. However, the efficacy of this medical treatment administration remains unclear. To compare the efficacy (complete expulsion of retained product of conception (RPOC)) of medical treatment with misoprostol versus expectant management in women with retained product of conception after spontaneous early pregnancy loss or induced abortion. Surgical treatment was outside the scope of this manuscript. We conducted a systematic review according to the PRISMA guidelines. The search included PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science and Cochrane Library electronic databases from inception to 02-05-2024. Our systematic review included studies concerning retained product of conception after incomplete early pregnancy loss or abortion that were managed expectantly of medically (with misoprostol). Complete early pregnancy loss or surgical treatment studies were excluded. A total of 1831 records were screened, and 2 studies were included. One randomized controlled trial (RCT) and 1 retrospective cohort study. The RCT did not demonstrate any significant difference between expectant management (N = 36/63 (57.1%), RR: 1.12, 95% CI (0.74-1.70), P = 0.590 ) or secondary medical treatment (N = 42/68 (61.8%), RR: 1.12, 95% CI (0.74-1.70), P = 0.590). Surgical intervention was avoided in 60% of the cases. The results of the retrospective case series showed a 64.4% efficacy for misoprostol versus 91.8% efficacy 3 weeks after expectant treatment. Despite the high incidence of early pregnancy loss, the lack of data is compelling. The limited data in this systematic review do not show any significant differences between expectant management or medical treatment at 3 to 4 weeks for RPOC in case of incomplete early pregnancy loss or abortion.