Table I.7.15GRADE findings for comparison of oral misoprostol in different dosages for the management of incomplete miscarriage

Quality assessmentNumber of women or averageEffectQuality
Number of studiesDesignLimitationsInconsistencyIndirectnessImprecisionDetails of treatment regimen (dose in micrograms unless stated)600 micrograms oral2 × 600 micrograms oralRelative (95% CI)Absolute (95% CI) and P value (if stated)
Success of medical treatment
1 meta-analysis of 2 studies

(Blanchard et al., 2004; Ngoc et al., 2005)
randomised trialsserious1no serious inconsistencyno serious indirectnessno serious imprecisionOral misoprostol (Ms) 600 vs.

2 × 600
199/236

(84.3%)
195/233

(83.7%)
RR 1.01

(0.94 to 1.09)
8 more per 1000

(from 50 fewer to 75 more)
Moderate
Need for further intervention
1 meta-analysis of 2 studies

(Blanchard et al., 2004; Ngoc et al., 2005)
randomised trialsserious1no serious inconsistencyno serious indirectnessserious2Oral Ms 600 vs. 2 × 60035/234

(15%)
32/227

(14.1%)
RR 1.05

(0.69 to 1.59)
7 more per 1000

(from 44 fewer to 83 more)
Low
Adverse effects: incidence of nausea
1 meta-analysis of 2 studies
(Blanchard et al., 2004; Ngoc et al., 2005)
randomised trialsserious1serious3no serious indirectnessserious2Oral Ms 600 vs. 2 × 60048/235

(20.4%)
37/228

(16.2%)
RR 1.19

(0.57 to 2.46)
31 more per 1000

(from 70 fewer to 237 more)
Very low
Adverse effects: incidence of vomiting
1 meta-analysis of 2 studies

(Blanchard et al., 2004; Ngoc et al., 2005)
randomised trialsserious1no serious inconsistencyno serious indirectnessserious2Oral Ms 600 vs. 2 × 60025/235

(10.6%)
24/228

(10.5%)
RR 1.01

(0.6 to 1.72)
1 more per 1000

(from 42 fewer to 76 more)
Low
Adverse effects: incidence of diarrhoea
1 study

(Ngoc et al., 2005)
randomised trialserious1no serious inconsistencyno serious indirectnessno serious imprecisionOral Ms 600 vs. 2 × 60051/149

(34.2%)
68/145

(46.9%)
RR 0.73

(0.55 to 0.97)
127 fewer per 1000

(from 14 fewer to 211 fewer)
Moderate
Adverse effects: incidence of fever or chills
1 meta-analysis of 2 studies

(Blanchard et al., 2004; Ngoc et al., 2005)
randomised trialsserious1no serious inconsistencyno serious indirectnessserious2Oral Ms 600 vs. 2 × 60027/235

(11.5%)
22/228

(9.6%)
RR 1.19

(0.7 to 2.02)
18 more per 1000

(from 29 fewer to 98 more)
Low
Duration of heavy bleeding (days)
1 study

(Ngoc et al., 2005)
randomised trialserious1no serious inconsistencyno serious indirectnessno serious imprecisionOral Ms 600 vs. 2 × 600Mean 0.8

(SD 0.8)

n = 149
Mean 0.8

(SD 0.7)

n = 145
not calculable (NC)MD 0 higher

(0.17 lower to 0.17 higher)

NS (P value NR)
Moderate
1 study

(Blanchard et al., 2004)
randomised trialserious1no serious inconsistencyno serious indirectnessserious4Oral Ms 600 vs. 2 × 600Mean 1.31

(SD not reported (NR))

N = 86
Mean 1.63

(SD NR)

n = 83
NCMD 0.32 lower
(confidence interval NC)
P = 0.21
Low
Duration of normal bleeding (days)
1 study

(Ngoc et al., 2005)
randomised trialserious1no serious inconsistencyno serious indirectnessno serious imprecisionOral Ms 600 vs. 2 × 600Mean 1.2

(SD 0.9)

n = 149
Mean 1.2

(SD 1.2)

n = 145
NCMD 0 higher

(0.24 lower to 0.24 higher)

NS (P value NR)
Moderate
1 study

(Blanchard et al., 2004)
randomised trialserious1no serious inconsistencyno serious indirectnessserious4Oral Ms 600 vs. 2 × 600Mean 2.86

(SD NR)

n = 86
Mean 2.76

(SD NR)

n = 83
NCMD 0.1 higher

(confidence interval NC)
P = 0.79
Low
Duration of light bleeding or spotting (days)
1 study

(Ngoc et al., 2005)
randomised trialserious1no serious inconsistencyno serious indirectnessno serious imprecisionOral Ms 600 vs. 2 × 600Mean 2.1

(SD 2.1)

n = 149
Mean 1.8

(SD 2.1)

n = 145
NCMD 0.3 higher

(0.18 lower to 0.78 higher)

NS (P value NR)
Moderate
1 study

(Blanchard et al., 2004)
randomised trialserious1no serious inconsistencyno serious indirectnessserious4Oral Ms 600 vs. 2 × 600Mean 2.94

(SD NR)

n = 86
Mean 2.88

(SD NR)

n = 83
NCMD 0.06 higher

(confidence interval NC)

P = 0.89
Low
Pain: incidence
1 meta-analysis of 2 studies

(Blanchard et al., 2004; Ngoc et al., 2005)
randomised trialsserious1no serious inconsistencyno serious indirectnessno serious imprecisionOral Ms 600 vs. 2 × 600182/235

(77.4%)
183/228

(80.3%)
RR 0.97

(0.88 to 1.06)
24 fewer per 1000

(from 96 fewer to 48 more)
Moderate
Pain: severity/7
1 study

(Ngoc et al., 2005)
randomised trialserious1no serious inconsistencyno serious indirectnessserious4Oral Ms 600 vs. 2 × 600Mean 3.7
(SD NR)

n = 149
Mean 3.6
(SD NR)

n = 145
NCMD 0.1 higher

(confidence interval NC)

NS

(P value NR)
Low
1 study

(Blanchard et al., 2004)
randomised trialserious1no serious inconsistencyno serious indirectnessserious4Oral Ms 600 vs. 2 × 600Mean 3.65

(SD NR)

n = 85
Mean 4.09

(SD NR)

n = 81
NCMD 0.44 lower

(confidence interval NC)

P = 0.20
Low
Satisfaction: reported incidence
1 meta-analysis of 2 studies

(Blanchard et al., 2004; Ngoc et al., 2005)
randomised trialsserious1no serious inconsistencyno serious indirectnessno serious imprecisionOral Ms 600 vs. 2 × 600211/234

(90.2%)
199/226

(88.1%)
RR 1.02

(0.96 to 1.09)
18 more per 1000

(from 35 fewer to 79 more)
Moderate

CI confidence interval, MD mean difference, Ms misoprostol, NC not calculable, NR not reported, P probability, RR relative risk, SD standard deviation

1

Lack of blinding

2

Wide confidence intervals

3

High heterogeneity (I2 > 60%)

4

Standard deviation not reported

From: Appendix I, GRADE tables

Cover of Ectopic Pregnancy and Miscarriage
Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage.
NICE Clinical Guidelines, No. 154.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG; 2012 Dec.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.