***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS The purpose of this r and omized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men 's resolution of depression and grief during the first year after miscarriage . METHODS Three hundred forty-one couples were r and omly assigned to nurse caring ( NC ) ( three counseling sessions ) , self-caring ( SC ) ( three video and workbook modules ) , combined caring ( CC ) ( one counseling session plus three SC modules ) , or control ( no treatment ) . Interventions , based on Swanson 's Caring Theory and Meaning of Miscarriage Model , were offered 1 , 5 , and 11 weeks after enrollment . Outcomes included depression ( CES-D ) and grief , pure grief ( PG ) and grief-related emotions ( GRE ) . Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework . RESULTS Bayesian odds ( BO ) ranging from 3.0 to 7.9 favored NC over all other conditions for accelerating women 's resolution of depression . BO of 3.2 - 6.6 favored NC and no treatment over SC and CC for resolving men 's depression . BO of 3.1 - 7.0 favored all three interventions over no treatment for accelerating women 's PG resolution , and BO of 18.7 - 22.6 favored NC and CC over SC or no treatment for resolving men 's PG . BO ranging from 2.4 to 6.1 favored NC and SC over CC or no treatment for hastening women 's resolution of GRE . BO from 3.5 to 17.9 favored NC , CC , and control over SC for resolving men 's GRE . CONCLUSIONS NC had the overall broadest positive impact on couples ' resolution of grief and depression . In addition , grief resolution ( PG and GRE ) was accelerated by SC for women and CC for men OBJECTIVE To compare the efficacy of intramuscular methotrexate plus vaginal misoprostol to vaginal misoprostol alone in completing  abortion in women with non-viable early first trimester pregnancy . METHOD Twenty-one women with non-viable pregnancy up to 49 days gestation were r and omized to receive intramuscular methotrexate , followed 2 days later by vaginal misoprostol or misoprostol alone . We also collected patient satisfaction information . RESULT Complete abortion occurred in all 12 ( 100 % ) women in the combined group and eight of nine ( 89 % , RR = 1.13 , CI 0.89 - 1.42 ) women in the misoprostol only group . Of the women , 75 % rated their experience as good and would choose medical management again . CONCLUSION Either methotrexate plus misoprostol or misoprostol alone effectively completed abortion in women with non-viable early pregnancy and represent acceptable medical alternatives to surgery or expectant management Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This study was design ed to investigate the use of oral mifepristone ( RU 486 ) for the induction of natural expulsion of concepti in women with spontaneously interrupted pregnancy in the first trimester . It consisted of a double-blind placebo-controlled study of mifepristone ( 600 mg ) against placebo . A total of 46 women consulting for interrupted pregnancy were diagnosed at ultrasound with no clinical sign of miscarriage . Measurements were made of the occurrence of natural expulsion , the frequency of complete expulsion , the need for subsequent surgical evacuation , analgesia and the need for transfusion . Natural expulsion occurred within 5 days in 82 % of patients receiving mifepristone treatment versus 8 % of placebo-treated patients ( P < 0.001 ) . All patients experienced bleeding after RU 486 and two needed emergency aspiration for haemorrhagic expulsion . The treatment failed in four patients , who underwent evacuation under local anaesthesia . In the control group , 19 patients underwent evacuation  under local ( n = 10 ) or general ( n = 9 ) anaesthesia . It was concluded that a st and ard oral pilot dose of 600 mg of mifepristone induces natural expulsion in 82 % of women with non-developing first trimester intrauterine pregnancies BACKGROUND Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination . This is the first r and omized study to compare vaginal misoprostol versus expectant treatment in women presenting with spontaneous miscarriage . METHODS Sixty women presenting with spontaneous miscarriage were recruited to the study at the Queen Mary Hospital between 1998 and 1999 . They were r and omized to group 1 : misoprostol ; and group 2 : expectant management . Women in the misoprostol group received vaginal misoprostol 400 microg on days 1 , 3 and 5 . The expectant group was followed up according to the same schedule . Suction evacuation was performed if there was excessive bleeding or abdominal pain ; or if a gestational sac was detected by transvaginal scan on day 15 . RESULTS Fifty-nine women completed the trial . Those who did not require suction evacuation up to the time of return of normal menstruation were considered to be successful . The incidence of side-effects was comparable between the two groups . Three women in the expectant group and one in the misoprostol group underwent emergency suction evacuation because of excessive bleeding . The mean duration of vaginal bleeding was similar for both groups ( 14.6 days in the misoprostol group versus 15.0 days in the expectant group ) . The successful rate in the misoprostol group was significantly higher than that of the expectant group ( 83.3 versus 48.3 % , P < 0.05 ) . CONCLUSION We recommend repeated vaginal misoprostol 400 microg given on days 1 , 3 and 5 as a treatment option for women with first trimester spontaneous miscarriage OBJECTIVE To examine rates of conception and pregnancy loss and their relations with time to clinical pregnancy and reproductive outcomes . DESIGN A prospect i ve observational study . SETTING Population -based cohort in China . PATIENT(S ) Five hundred eighteen healthy newly married women who intended to conceive . Upon stopping contraception , daily records of vaginal bleeding and daily first-morning urine specimens were obtained for < or = 1 year or until a clinical pregnancy was achieved . Daily urinary hCG was assayed to detect  early pregnancy loss ( EPL ) . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Conception , pregnancy loss , and time to clinical pregnancy . RESULT ( S ) The conception rate per cycle was 40 % over the first 12 months . Of the 618 detectable conceptions , 49 ( 7.9 % ) ended in clinical spontaneous abortion , and 152 ( 24.6 % ) in EPL . Early pregnancy loss was detected in 14 % of all the cycles without clinical ly recognized pregnancy , but the frequencies were lower among women with delayed time to clinical pregnancy . Early pregnancy loss in the preceding cycle was associated with increased odds of conception ( odds ratio [ OR ] , 2.6 ; 95 % confidence interval [ CI ] , 1.8 - 3.9 ) , clinical pregnancy ( OR , 2.0 ; 95 % CI , 1.3 - 3.0 ) , and EPL ( OR , 2.4 ; 95 % CI , 1.4 - 4.2 ) but was not associated with spontaneous abortion , low birth weight , or preterm birth in the subsequent cycle . CONCLUSION ( S ) We demonstrated substantial EPL in the non- clinical ly pregnant cycles and a positive relation between EPL and subsequent fertility Abstract Objective To ascertain whether a clinical ly important difference exists in the incidence of gynaecological infection between surgical management and expectant or medical management of miscarriage . Design R and omised controlled trial comparing medical and expectant management with surgical management of first trimester miscarriage . Setting Early pregnancy assessment units of seven hospitals in the United Kingdom . Participants Women of less than 13 weeks ' gestation , with a diagnosis of early fetal demise or incomplete miscarriage . Interventions Expectant management ( no specific intervention ) ; medical management ( vaginal dose of misoprostol preceded , for women with early fetal demise , by oral mifepristone 24 - 48 hours earlier ) ; surgical management ( surgical evacuation ) . Main outcome measures Confirmed gynaecological infection at 14 days and eight weeks ; need for unplanned admission or surgical intervention . Results 1200 women were recruited : 399 to expectant management , 398 to medical management , and 403 to surgical management . No differences were found in the incidence of confirmed infection within 14 days between the expectant group ( 3 % ) and the surgical group ( 3 % ) ( risk difference 0.2 % , 95 % confidence interval − 2.2 % to 2.7 % ) or between the medical group ( 2 % ) and the surgical group ( 0.7 % , − 1.6 % to 3.1 % ) . Compared with the surgical group , the number of unplanned hospital admissions was significantly higher in both the expectant group ( risk difference − 41 % , − 47 % to − 36 % ) and the medical group ( − 10 % , − 15 % to − 6 % ) . Similarly , when compared with the surgical group , the number of women who had an unplanned surgical curettage was significantly higher in the expectant group ( risk difference − 39 % , − 44 % to − 34 % ) and the medical group ( − 30 % , − 35 % to − 25 % ) . Conclusions The incidence of gynaecological infection after surgical , expectant , and medical management of first trimester miscarriage is low ( 2 - 3 % ) , and no evidence exists of a difference by the method of management . However , significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management and medical management than after surgical management . Trial registration National Research Register : N0467011677/N0467073587 Abstract Objective To compare the efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in the management of  early pregnancy failure ( EPF ) . Study Design A r and omized double-blind placebo-controlled clinical trial . Methods Ninety-two women with EPF ≤12 weeks were recruited and r and omly allocated to receive either mifepristone 200 mg ( n = 46 ) or placebo ( n = 46 ) . Forty-eight hours later , patients in both the groups were given 800 µg misoprostol per-vaginum . If no expulsion occurred within 4 h , repeat doses of 400 µg misoprostol were given orally at 3-hourly interval to a maximum of 2 doses in women ≤9 weeks by scan and 4 doses in women > 9 weeks by scan . Results Pre-treatment of misoprostol with mifepristone significantly increased the complete abortion rate ( 86.7 vs. 57.8 % , p = 0.009 ) and , hence , reduced the need for surgical evacuation ( 13.3 vs. 42.2 % , p = 0.002 ) , induction to expulsion interval ( 4.74 ± 2.24 vs. 8.03 ± 2.77 h , p = 0.000 ) , mean number of additional doses of misoprostol required ( 0.68 vs. 1.91 , p = 0.000 ) , and side effects . Conclusion Use of mifepristone prior to misoprostol in EPF significantly improves the efficacy and reduces the side effects of misoprostol alone OBJECTIVE To compare the effect of vaginal misoprostol with that of placebo when used prior to dilation and aspiration in women with a missed abortion . METHOD Eighty-four pregnant women with a missed abortion were r and omized to receive either vaginal misoprostol ( 200 micrograms ) or placebo the day before the planned dilatation and aspiration under inhalation anesthesia . RESULT Thirty-five women ( 83.33 % ) in the misoprostol group and 6 women ( 17.14 % ) in the placebo group aborted spontaneously prior to the scheduled dilatation and aspiration , P < 0.0001 . The mean insertion to spontaneous expulsion time was 11.63 + /- 6.14 h in the misoprostol group compared to 11.95 + /- 5.43 h in placebo . In the misoprostol group two women required intramuscular pethidine for analgesia . In the placebo group there were two cases of blood loss in excess of 500 ml and one woman with a uterine perforation . CONCLUSION Vaginal administration of misoprostol to women with a missed abortion produced spontaneous expulsion of the pregnancy and reduced the need for surgical treatment BACKGROUND Mifepristone and a prostagl and in have been used successfully to terminate pregnancy in Europe and China . We report the results of a large U.S. study of mifepristone and misoprostol in women with pregnancies of up to nine weeks ' duration . METHODS We administered 600 m 
    Output:
    
We detected unexplained inconsistency in evidence loops involving MIFE+MISO and adjusted for it .
EXP had lower effectiveness compared to other treatment options .
The effectiveness of medical treatments was similar compared to surgery .
WIDER IMPLICATION S Medical treatments for first-trimester miscarriage have similar effectiveness and side effects compared to surgery .
The addition of MIFE could increase the effectiveness of MISO and reduce side effects , although evidence is limited due to inconsistency .
EXP has lower effectiveness compared to other treatment options .