Meta-analysis shows surgical management improves success rates and shortens bleeding in missed miscarriage compared to medical management.

BackgroundComparative evidence regarding the efficacy and safety of medical versus surgical management for missed miscarriage has not been consistently evaluated.MethodsThe 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.ResultsThe seven included studies (four RCTs and three cohort studies) were conducted between 1994 and 2025, with a total of 1,637 patients with missed miscarriage. We found that surgical management demonstrates superior clinical efficacy and safety compared to medical management, with higher success rate [risk difference (RD) = 0.26, 95% confidence interval (95% CI): 0.14 to 0.39, P < 0.001], shorter bleeding duration [weighted mean difference (WMD) = −2.72, 95% CI: −4.53 to −0.92, P < 0.001] and fewer complications (RD = −0.29, 95% CI: −0.43 to −0.15, P < 0.001). No significant difference in infection rate (RD = −0.02, 95% CI = −0.07 to 0.03, P = 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.ConclusionSurgical 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.