Medical treatment for early fetal death (less than 24 weeks)

Cochrane Review by Neilson JP, Hickey M, Vazquez J

This record should be cited as: Neilson JP, Hickey M, Vazquez J. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD002253. DOI: 10.1002/14651858.CD002253.pub3.



Medical treatment for early fetal death (less than 24 weeks)


In most pregnancies that miscarry, arrest of embryonic or fetal development occurs some time (often weeks) before the miscarriage occurs. Ultrasound examination can reveal abnormal findings during this phase by demonstrating anembryonic pregnancies or embryonic or fetal death. Treatment before 14 weeks has traditionally been surgical but medical treatments may be effective, safe, and acceptable, as may be waiting for spontaneous miscarriage.


To assess the effectiveness, safety and acceptability of any medical treatment for early pregnancy failure (anembryonic pregnancies or embryonic and fetal deaths before 24 weeks).

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 November 2005).

Selection criteria

Randomised trials comparing medical treatment with another treatment (e.g. surgical evacuation), or placebo, or no treatment for early pregnancy failure. Quasi-random studies were excluded.

Data collection and analysis

Data were extracted unblinded.

Main results

Twenty four studies (1888 women) were included.

Authors' conclusions

Available evidence from randomised trials supports the use of vaginal misoprostol as a medical treatment to terminate non-viable pregnancies before 24 weeks. Further research is required to assess effectiveness and safety, optimal route of administration and dose. Conflicting findings about the value of mifepristone need to be resolved by additional study.