In a nutshell
This paper compared the effectiveness and safety of expectant compared to surgical management of first-trimester (0-13 weeks) miscarriage (loss of fetus).
Some background
After a miscarriage, surgical evacuation is done to remove tissue and substances left behind in the uterus. It is associated with side effects such as infection. Uterine curettage (removal of the contents of the uterus with an instrument called curettage) is commonly performed in a missed miscarriage (fetus with no heart activity) or incomplete miscarriage (part of tissue stays in body) .
Expectant management, where one waits and monitors the situation, has emerged as an alternative to surgical evacuation. Expectant management results in complete evacuation in 79% of cases. It is easy, effective, safe and cost-effective.
Methods & findings
217 women with missed miscarriage and incomplete miscarriage were analyzed. The women were in their first trimester (less than 13 weeks of pregnancy). The women were randomly assigned to either an expectant management group or a surgical management group. Women in surgical management group underwent surgical uterine evacuation. Women in expectant management group were advised to use paracetamol (Panadol) tablets to relieve pain.
81.4% of patients undergoing expectant management were successful with loss of uterine contents within 4 weeks. 18.6% had to have surgical uterine evacuation because products still remained in the uterus.
95.7% of women in the surgical group had successful evacuation of uterus. 5.2% had emergency surgical uterine evacuation. 4.3% had second curettage due to incomplete evacuation in first procedure.
The average duration of bleeding was 11 days in expectant group and 7 days in surgical group. The average duration of pain was 8.1 days in the expectant group and 5.5 days in the surgical group.
The rate of complications were 5.9% in the expectant group and 6.1% in the surgical group. 1.9% of women in expectant group and 3.5% of women in surgical group were diagnosed and treated with pelvic infection.
The bottom line
The authors concluded that expectant management of women with first-trimester miscarriage is safe and effective, but surgical management is more successful.
What’s next?
Talk to your doctor about the pros and cons of expectant vs surgical management of miscarriage.
Published By :
Archives of Gynecology and Obstetrics
Date :
May 01, 2014
