Comparative efficacy and safety of medical and surgical management for missed miscarriage: a systematic review and meta-analysis

Background: Comparative evidence regarding the efficacy and safety of medical versus surgical management for missed miscarriage has not been consistently evaluated. Methods: The meta-analysis was in line with the PRISMA 2020 and MOOSE guidelines. The Web of Science, PubMed, Embase, and ScienceDirect databases were searched for eligible studies. The outcomes were the success rate, bleeding duration, infection rate and complication rate. The pooled results were synthesized via random-effect model. Influential publication was determined by performing sensitivity analysis. In addition, the potential sources of heterogeneity were examined by using subgroup analyses. Publication bias was assessed using the funnel plot, Begg's and Egger's tests. Results: = 0.404). Subgroup analysis showed that patients' mean gestational week was the potential source of heterogeneity. No influential publications and significant publication bias were detected across studies. Conclusion: Surgical management demonstrates superior clinical efficacy and safety compared to medical management, especially in pregnancies with earlier gestational age. A truly patient-centered approach must balance individual preferences, gestational age, follow-up access, and awareness of clinical risks.