Table I.7.17GRADE findings for comparison of oral misoprostol with sublingual misoprostol for the management of incomplete miscarriage

Quality assessmentNumber of women or averageEffectQuality
Number of studiesDesignLimitationsInconsistencyIndirectnessImprecisionDetails of treatment regimen (dose in microgram unless stated)OralSublingualRelative (95% CI)Absolute (95% CI) and P value (if stated)
Success of medical treatment
1 study

(Paritakul & Phupong, 2011)
randomised trialserious1no serious inconsistencyno serious indirectnessserious2Oral: 600 misoprostol (Ms)

Sublingual: 600 Ms
28/32

(87.5%)
27/32

(84.4%)
RR 1.04

(0.85 to 1.26)
34 more per 1000

(from 127 fewer to 219 more)
Low
Need for further intervention
1 study

(Paritakul & Phupong, 2011)
randomised trialserious1no serious inconsistencyno serious indirectnessserious2Oral: 600 Ms

Sublingual: 600 Ms
2/32

(6.3%)
5/32

(15.6%)
RR 0.4

(0.08 to 1.91)
94 fewer per 1000

(from 144 fewer to 142 more)
Low
Adverse effects: incidence of nausea
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious2Oral: 600 Ms

Sublingual: 600 Ms
7/32

(21.9%)
8/32

(25%)
RR 0.88

(0.36 to 2.13)
30 fewer per 1000

(from 160 fewer to 283 more)
Moderate
Adverse effects: incidence of vomiting
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious3Oral: 600 Ms

Sublingual: 600 Ms
0/32

(0%)
0/32

(0%)
not calculable (NC)NCModerate
Adverse effects: incidence of diarrhoea
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious2Oral: 600 Ms

Sublingual: 600 Ms
5/32

(15.6%)
9/32

(28.1%)
RR 0.56

(0.21 to 1.48)
124 fewer per 1000

(from 222 fewer to 135 more)
Moderate
Adverse effects: incidence of fever/chills
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious2Oral: 600 Ms

Sublingual: 600 Ms
9/32

(28.1%)
14/32

(43.8%)
RR 0.64

(0.33 to 1.27)
157 fewer per 1000

(from 293 fewer to 118 more)
Moderate
Incidence of heavy bleeding
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious3Oral: 600 Ms

Sublingual: 600 Ms
0/32

(0%)
0/32

(0%)
NCNCModerate
Pain: incidence of pain/cramps
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious2Oral: 600 Ms

Sublingual: 600 Ms
8/32

(25%)
10/32

(31.3%)
RR 0.8

(0.36 to 1.76)
62 fewer per 1000

(from 200 fewer to 237 more)
Moderate
Pain: severity/100
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionOral: 600 Ms

Sublingual: 600 Ms
Mean 22.2 (SD 15.0)

n = 32
Mean 29.1 (SD 21.2)

n = 32
NCMD 6.9 lower

(15.9 lower to 2.1 higher)

(P = 0.139)
High
Satisfaction: reported incidence
1 study

(Paritakul & Phupong, 2011)
randomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious2Oral: 600 Ms

Sublingual: 600 Ms
28/32

(87.5%)
27/32

(84.4%)
RR 1.04

(0.85 to 1.26)
34 more per 1000

(from 127 fewer to 219 more)
Moderate

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

1

Lack of blinding

2

Wide confidence intervals

3

No events in either arm of the trial

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.

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